Cerebrovascular disease occurs due to a critical decline of the brain blood flow, leading to cell ischemia. Stroke remains the third most significant cause of death and disability worldwide. Studies on the treatment of acute ischemic stroke show that the evolving endovascular stroke treatment methods have reduced patient morbidity and mortality. However, a proper selection of patients is critical to achieve better functional results. This article reviews the results of the most recent research in mechanical thrombectomy in patients with acute ischemic stroke. The authors discuss possibilities to raise the effectiveness of endovascular therapy by increasing the therapeutic window when using the concept of clinical or perfusion imaging discrepancy, organizational interventions to reduce time before the start of reperfusion therapy, the selection of patients considering the lesion volume, using modern devices with improved characteristics for thrombectomy, conducting thrombectomy in elderly patients and endovascular interventions in basilar artery occlusion, using a combined reperfusion therapy strategy, consideration of the features of endovascular interventions in cerebral atherosclerosis, using trans-radial approach and optimal strategies to improve the «first-pass effect».