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BACKGROUND : Treatment of acute ischemic stroke changes rapidly. The purpose of this article is to present current therapeutic options. MATERIAL AND METHODS : The review is based on relevant literature found through a Medline search and on personal clinical experience. RESULTS : Acute treatment of ischemic stroke encompasses specific therapy aimed at recanalising the occluded vessel (chemical or mechanical thrombolysis) and treatment aimed at protection from the cellular consequences of ischemia (neuroprotection). Acute treatment also encompasses general stabilisation of a critically ill patient; with focus on blood pressure, cardiovascular function, airways, breathing and metabolic disturbances such as hyperglycemia and hyperthermia. Time is a crucial single factor for treatment effect. A rapid chain of delivery and a well-functioning stroke unit are therefore necessary prerequisites for effective acute stroke treatment. INTERPRETATION : Effective treatment of acute ischemic stroke is available and should whenever possible be evidence-based. Treatment based on experience and pathophysiological reasoning should be used when scientific evidence lacks.

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