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Acute ischemic stroke (AIS) is one of the serious diseases endangering human health worldwide;it usually leads to serious handicap with a high risk of recurrence and death.Despite the global burden of stroke, great advances are still being made.Since the publication of the 2013 guidelines for the early management of AIS patients, new high-quality evidence has resulted in prominent changes in the evidence-based treatment of AIS, such as image assessment, treatment beyond the time-window, new thrombolytic drugs, thrombolysis for strokes with an unknown onset time, and dual antiplatelet therapy for minor strokes.Especially in 2015, publication of the results of five clinical trials on mechanical thrombectomy contributed to the focused update of the 2013 guidelines for the early management of patients with AIS regarding endovascular treatment.Five years later, the publication of the DAWN and DEFUSE 3 results focusing on AIS beyond 6 h from onset demonstrated a significant benefit of mechanical thrombectomy for selected stroke patients 6 h-24 h from onset.Consequently, the American Heart Association/ American Stroke Association (AHA/ASA) issued newguidelines to supersede the 2013 guidelines in January 2018 [1], of which certain chapters were unfortunately deleted due to controversy.Here, we highlight some of the new recommendations and comment on imaging evaluation, intravenous (IV) thrombolysis, mechanical thrombectomy, and antiplatelet treatment from the AHA/ASA and the China 2018-2019 AIS guidelines [2, 3].