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Acute intracranial stroke is a major source of morbidity and mortality in the United States. Recent studies have shown improved clinical outcomes for patients who achieve timely arterial recanalization. Multimodal therapies have evolved to meet this end point and include intravenous and/or intra-arterial thrombolysis and mechanical thrombolysis. Modifications to existing balloon-mounted stents commonly used in cardiology have yielded more easily navigable and safer self-expanding intracranial stents that provide rapid arterial recanalization. We review the evolution of acute stroke therapy over the past few decades and the recent results of mechanical thrombolysis, focusing on intracranial stenting in the setting of acute stroke.