The last decade witnessed significant and unprecedented advances in the treatment of acute ischemic stroke. Intravenous tissue plasminogen activator and defibrinogenating agent are both now approved by the Food and Drug Administration for treatment of acute ischemic stroke within 3 h of symptom onset. Trials involving intra-arterial thrombolysis have demonstrated clinical benefit in patients treated within 6 h of symptom onset. The future for the development of new and better treatment for ischemic stroke looks very promising. Currently, induced hypothermia, laser evaporation, mechanical thrombectomy, angioplasty with stent placement, the combination of neuroprotective agents with thrombolysis, and the combination of intravenous with intra-arterial thrombolysis are being investigated.