The key to the treatment of acute ischemic stroke (AIS) is the early opening of occluded vessels and restoration of blood flow to save the ischemic semidark zone tissue. However, due to the strict time window (3-4.5h) and the low recanalization rate of combined large artery occlusion (13%-18%), less than 3% of patients can benefit from this treatment, and the 90-d mortality and disability rates are as high as 21% and 68%, which is not satisfactory. In recent years, some new endovascular devices (stenting devices and thrombus aspiration devices) have been used in clinical practice, which have significantly improved the opening rate of occluded vessels, and endovascular therapy (arterial thrombolysis, intravascular thrombectomy, angioplasty stenting) has shown good prospects for application. However, in terms of target population and time window selection, optimal treatment process, and long-term benefits, there is a lack of positive clinical randomized controlled studies, and endovascular treatment with AIS will probably remain as a complementary or remedial treatment for patients with large arterial occlusions in which intravenous thrombolysis is contraindicated or ineffective for quite some time. Endovascular treatment methods (a) intra-arterial thrombolysis Recommendations: 1. Patients with severe stroke caused by middle cerebral artery occlusion within 6 h of onset and not suitable for or ineffective for intravenous thrombolysis can undergo arterial thrombolysis in a hospital where available after strict selection; for patients with severe stroke caused by posterior circulation artery occlusion and not suitable for or ineffective for intravenous thrombolysis, the time window can be relatively extended The clinical prognosis after arterial thrombolysis is highly dependent on the start of treatment. For patients who are suitable for arterial thrombolysis, the key to treatment is the rapid initiation of patient screening, transport and multidisciplinary participation in the “green channel” or clinical pathway. (b) Endovascular mechanical opening (using stenting, thrombus aspiration and other methods) Recommendations: 1. For carefully selected patients with severe stroke within 8 h of onset (posterior circulation may be extended to 24 h if appropriate), endovascular mechanical opening by experienced neurointerventional physicians under the guidance of rapid imaging is recommended only in units where available, but the effect of improving patient prognosis is uncertain and needs to be determined on an individual basis. The decision needs to be made according to individual patient characteristics. 2. The new generation of stent embolization devices are generally better than the previous ones. (C) Angioplasty Recommendations: 1. For carefully selected patients with severe stroke within 8 h of onset (posterior circulation can be extended to 24 h if appropriate), patients who have failed arterial thrombolysis or are not suitable for endovascular thrombolysis, or patients with underlying stenosis of the combined intracranial arteries, emergency angioplasty or stenting by experienced neurointerventional physicians is recommended only in units where available. Further randomized controlled trials are needed to confirm the efficacy. The efficacy of emergency extracranial carotid or vertebral artery angioplasty/stenting in nonselective patients is unproven and is limited to specific conditions, such as acute ischemic stroke due to high stenosis or entrapment of the extracranial segment of the atherosclerotic responsible vessel.