This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources. Telemedicine is also discussed as it has been shown to be advantageous for augmenting thrombolytic administration for acute ischemic stroke. Due to technical advances, it has been easier to provide such service, but hurdles need to be resolved so it can be fully implemented. It is likely that telemedi­cine will also play a role in thrombectomy. This article proposes how thrombectomy could be delivered in Iceland. It will prove difficult to provide such complex treatment in a scattered population of 343.000 people where expertise is limited to one or two sites. It is important to remember, that coronary intervention was a formidable challenge at one time, but it was accomplished. Can we learn from that experience?

Table I. Modified Rankin Scale.

Table II. Different scales.

Table III. Indication for thrombectomy in patients with confirmed proximal occlusion / stenosis of middle cerebral artery or the internal carotid artery.