Abstract: Acute ischemic stroke(AIS), characterized by its high morbidity, high mortality, and high disability, is the most common subtype of stroke. Rapidly recanalizing the occluded arteries to salvage ischemic parenchyma in the early stage is essential to treat AIS, which mainly includes intravenous thrombolysis and endovascular treatment. The reperfusion therapy of AIS has been studied for over thirty years developing from intravenous thrombolysis(IVT) to endovascular treatment. There are three main stages in the evolution of reperfusion therapy:(1)investigating thrombolytic agents, which commenced the era of IVT in treating AIS; (2)investigating the dose and time window of thrombolytic agents to maximize the benefit and minimize the risk of IVT; (3)investigating mechanical thrombectomy for AIS, which contributes to the diversification and individualization of reperfusion therapy. Currently, IVT, bridging therapy, and direct mechanical thrombectomy can be applied to treating AIS according to the duration from the onset, the severity of clinical manifestation, and findings in the imaging examination.