The interventional treatment of acute ischemic stroke (AIS) began in the 1950s, when surgical approaches for cervical carotid disease (thrombendarteriectomy, bypass with vascular bridging graft, and diseased arterial segment resections) were first reported. In 1958, Bernard Sussman and Tom Fitch reported the first three cases of intraarterial (IA) infusion of fibrinolytics (fibrinolysin) to treat cerebral arterial occlusions [1]. The results were angiographically and clinically suboptimal but paved the way for future endovascular therapy investigations. In 1983, Herman Zeumer and his German colleagues reported the feasibility of IA fibrinolytic infusion (streptokinase) in five patients who had basilar artery occlusions (BAO) through 3F catheters placed in the distal cervical vertebral artery [2]. Zeumer was an early neuroradiologist who often thought “outside the box” and was an important innovator. Successful recanalization with clinical improvement occurred in three patients. A year later, the same authors reported the first two cases of IA infusion of urokinase into the internal carotid artery (ICA) to treat ICA occlusions [3].