The cumulative results of the SELECT-2, ANGEL-ASPECTS, and RESCUE-JAPAN LIMIT clinical trials suggest that endovascular thrombectomy performed within 24 h of symptom onset, in patients presenting with large ischemic strokes, defined by parenchymal and/or perfusion imaging, is safe and is associated with better functional outcomes with a treatment effect that persisted across all subgroups of patients. Our aim was to review these studies and to discuss the implications that these studies may have on patient selection, systems of care, and the utility of our imaging modalities.