Stroke Unit admission together with reperfusion strategies (intravenous thrombolysis and mechanical thrombectomy) are the main treatment options for acute ischemic stroke. The last 15 years have seen a revolution in the treatment of ischemic stroke: intravenous thrombolysis with recombinant tissue-type plasminogen activator is indicated within 4.5 h of symptom onset regardless of age or severity, whereas mechanical thrombectomy is indicated within 6 h of anterior circulation intracranial occlusion. In case of favorable mismatch, advanced neuroimaging allows wake-up or non-datable strokes or with late onset time windows to be treated with thrombolysis and/or thrombectomy (within 9 h for thrombolysis and 24 h for thrombectomy).