Up to the present, treatment strategies for acute cerebral ischemia have not shown scientifically proven efficacy. Based upon new knowledge on stroke pathogenesis and experimental data, new concepts of cerebral ischemia treatment are being clinically tested. The main therapeutic instrument is clot lysis by systemic or local application of thrombolytic drugs or the use of cytoprotective agents. For both treatment strategies clinical trials to show efficacy are ongoing or planned. Early reperfusion can be obtained by fibrinolysis, but its clinical usefulness has yet to be proven.