Background: Intra-arterial treatment is increasingly used in acute ischemic stroke. Recently, new devices have become available, aiming at better recanalization rates and outcome. We present a series of patients with acute stroke of the anterior circulation treated with intra-arterial therapy using intra-arterial thrombolysis and different types of mechanical devices. Methods: We prospectively gathered clinical and radiological data of all patients with acute anterior stroke who were treated with intra-arterial therapy in a Dutch teaching hospital between 2009 and 2011. Patients were grouped according to the intra-arterial treatment strategy and analyzed for poor outcome (modified Rankin Scale score >2 or death), complications and recanalization rate with the Poisson regression. Results: Eighty-four patients were treated with intra-arterial therapy, 13 with intra-arterial thrombolysis only (ND group), 22 with a Merci device (MERCI group) and 49 with a stent retriever (SR group). Overall, 52 patients (62%) had poor outcome of whom 17 (20%) died. There was a trend towards poorer outcome in the ND group (adjusted RR 1.18; 95% CI 0.74-1.88) and the MERCI group (adjusted RR 1.17; 95% CI 0.79-1.74) compared with the SR group. Furthermore, failed recanalization occurred more often in the ND group (adjusted RR 2.59; 95% CI 1.50-4.49) and MERCI group (adjusted RR 2.32; 95% CI 1.33-4.05) compared with the SR group. Conclusion: We found higher recanalization rates with SRs. However, this resulted only in a trend towards better clinical outcome.