The aim of this review is to discuss the different treatment strategies of acute stroke. The main studies performed with intravenous or intra-arterial thrombolysis are reported as well as the recent results concerning the use of IIb/IIIa platelet receptors antagonists. We will also discuss the potential effect of ultrasound on systemic thrombolysis. Finally are mentioned the most important measures to avoid medical and neurological complications which may occur during the acute phase of stroke.