Progress in acute stroke management during the past decade involved: (1) the organization of stroke services and fast referral to suitable stroke centers, (2) medical prevention treatment of patients with ischemic stroke during and after hospitalization including hypertension and blood glucose control, statins, carotid interventions, and novel antithrombotic use, and (3) thrombolysis and thrombectomy for patients with acute brain ischemia. In this Viewpoint, we discuss only the latter; it is the most en courant topic that demands future complex integrated organization of services.