The therapeutic management of acute ischemic stroke has changed tremendously over the past few years. Mechanical thrombectomy in addition to intravenous tissue plasminogen activator (t-PA) is currently the standard of care for patients experiencing acute ischemic stroke as a consequence of large vessel occlusion of the anterior circulation. Yet, despite strong evidence supporting such a therapeutic approach, several issues remain a source of debate, such as the need for intravenous t-PA, the optimal target for blood pressure levels and the opportunity for additional antithrombotic therapies to improve reperfusion. Given this perspective, periprocedural patient management is probably the next step to come with considerable changes.