Stroke is a major clinical challenge. The authors note that during the last 5–7 years, tremendous progress was achieved in the reperfusion treatment of acute ischemic stroke during its first few hours from symptom onset.

This review summarizes the latest evidence from randomized clinical trials and prospective registries, with a focus on endovascular treatment using stent retrievers, aspiration catheters, thrombolytics, and (in selected patients) carotid stenting.

Novel approaches in pre-hospital (mobile interventional stroke teams) and early hospital (direct transfer to angiography) management are described, and future perspectives (‘all-in-one’ laboratories with angiography and computed tomography integrated) are discussed.

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