Currently, we have just 1 established therapy: intravenous administration of recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of ischemic stroke symptom onset (2 - 3). Although this therapy has a substantial effect on clinical outcomes by leading to 1 fewer disabled patient for every 8 patients treated within 3 hours, it still leaves more than half of treated patients disabled. It is linked to Centers for Medicare & Medicaid Services (CMS) reimbursement of approximately $16 000 to hospitals (4). In addition, 1 small, randomized trial and a meta-analysis of 3 independent trials suggest clinical benefit associated with intra-arterial administration within 6 hours of stroke onset of a lytic that is no longer commercially available (recombinant prourokinase) (5 - 6). On the basis of these data, endovascular delivery of a different lytic agent, rt-PA, is now used as a treatment option without specific additional reimbursement from CMS beyond that of intravenously delivered rt-PA. Finally, we have neurothrombectomy devices, the subject of Baker and colleagues' review, which offer great hope for more effectively and more rapidly achieving recanalization of occluded proximal cerebral arteries.