Ischemic stroke is an important disease with high morbidity and mortality. Systemic fibrinolysis is well studied and has become the accepted international standard of acute therapy. Intraarterial lysis and intravascular mechanical treatment options are becoming increasingly important. The time window for acute therapies is limited to a few hours after the onset of symptoms. A substantial proportion of stroke is preceeded by a transient ischemic attack (TIA). The immediate identification of the cause of such a TIA and initiation of treatment can prevent as much as 80% of subsequent strokes. Recent clinical trials attempt to treat more patients with more individualized strategies.