Abstract: Intravenous thrombolysis and mechanical thrombectomy are well-established reperfusion therapies for acute ischemic stroke, which can significantly improve clinical outcomes compared to conventional treatments. However, both strategies face the following challenges: although it is the first-line treatment, intravenous thrombolysis suffers from low recanalization rates and a narrow therapeutic time window (3-4.5 h), which limits its clinical benefit. Mechanical thrombectomy, while achieving over 80% recanalization, still results in disability or death in more than 50% of patients. Future efforts should focus on optimizing thrombolytic drugs by developing novel agents with higher fibrin specificity and safety profiles, thus expanding the population benefiting from thrombolysis. Moreover, reperfusion therapy based on the “tissue window” could be achieved with utilizing advanced imaging techniques to break the traditional time window limitation. The promotion of mobile stroke units could facilitate ultra-early reperfusion treatment. Additionally, optimization of post-thrombolysis antithrombotic strategies is essential to prevent neurological deterioration. For mechanical thrombectomy, it is crucial to enhance perioperative management and actively explore neuroprotective strategies for further improvement of outcomes.

Key words: acute ischemic stroke, reperfusion therapy, intravenous thrombolysis, mechanical thrombectomy, mobile stroke unit