Stroke is the clinical syndrome of acute onset of neurologic deficit caused by ischemia or hemorrhage. Neuroimaging has a crucial role in differentiating ischemic from hemorrhagic stroke. Advanced neuroimaging has become essential in the management of patients with acute ischemic stroke mainly because of improved awareness of the imaging findings and their role in patient selection for novel treatment options as highlighted in recent clinical trials, including “late window” (8–24 hours post ictus!) intra-arterial thrombectomy. This article focuses on the role of neuroimaging in the management of patients with acute ischemic stroke.