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Purpose: To analyze the safety and efficacy of primary endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients younger than 18 years of age. Methods: Review of 4 patients < 18 years of age with AIS, prospectively enrolled in an electronic database registry for acute ischemic stroke patients who underwent thrombectomy at tertiary centers, from January 2011 to February 2017. Clinical and imaging data were analyzed. Results: All patients were female. Patients 1 to 4 were 14, 13, 16, and 13 years old, respectively. Patients 1 and 3 had left middle cerebral artery occlusion, patient 2 basilar occlusion, and patient 4 right tandem occlusion. Mean NIHSS score was 13 (7–19) on arrival and 4 (0–5) at 24 h. Patient 2 had Osler–Weber–Rendu disease and patient 4 a previously surgically repaired complete atrioventricular canal. All patients presented with clinical–radiological mismatch. CT/CTA was used in patients 1 and 4 and MRI/MRA in patients 2 and 3. Stent retriever was used in 3 patients (patients 1, 3, and 4) and direct aspiration first-pass technique in 1 (patient 2). All 4 procedures resulted in successful recanalization and 3-month functional independence. Conclusion: Primary EVT is reported in patients 13 to 16 years of age with AIS due to large vessel occlusion and clinical–radiological mismatch. Procedures were safe and effective with prompt recanalization and good clinical outcome. [ABSTRACT FROM AUTHOR]