Emerging evidence has led to an interim review of the existing 2022 Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, recommendations for endovascular treatment of acute ischemic stroke. This manuscript presents an update of the recommendations for endovascular treatment, addressing the issues of posterior circulation stroke, stroke with a large core and stroke with medium vessel occlusion (MeVO). These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments and management strategies, proven to reduce mortality and morbidity. These updated recommendations supersede the endovascular thrombectomy recommendations included in the 2022 publication of the CSBPR acute stroke management module. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca