In acute ischemic stroke due to large vessel occlusion; endovascular interventions in which the clot is removed mechanically are gold standard treatments. According to the guidelines and the results of the studies carried out in previous years, current practice is; If the patient does not have contraindications, IV rtPA is initiated before endovascular treatment without loss of time. However, in recent years there is a tendency in the direction of taking patients directly into the angiography unit and randomized controlled studies comparing these two groups are gaining weight. For direct endovascular intervention of patients; results have also been obtained showing that it may not be worse than combined therapy in recent studies. In the light of current studies, it is not yet possible to make clear choices between both approaches. For this reason, it would be a more logical approach to consider each patient separately and to make the right choice on the basis of the patient.