Thrombolysis remains the main therapeutic strategy used in stroke, but with a limited use to only a part of stroke patients. A neuroprotective approach would be necessary with a double objective : (1) to serve as an add-on treatment with thrombolysis to improve safety and increase therapeutic window ; (2) to limit infarct area by delaying neuronal death. While numerous molecules failed in clinical trials in stroke, pharmacological development is on-going with pleiotropic drugs targeting both neuronal and vascular parts of neurovascular unit. Another approach targets the functional rehabilitation and the neurorepair using pharmacological ways or cell therapy.