Acute ischemic stroke is a brain functional disorder, which cause high disability and mortality rate worldwide, the second most common cause of dementia, and the third leading cause of death. It has enormous clinical, social, and economic implications and demands a significant effort from both basic scientists and clinicians in the quest for understanding the underlying pathomechanisms and producing suitable preventive measures and successful therapies. Management of acute ischemic stroke has been revolutionized by the introduction of several interventions, such as prehospital and stroke unit care, intravenous tissue plasminogen activator therapy within 4.5 hours of stroke onset, aspirin therapy within 48 hours of stroke onset, decompressive craniectomy for supratentorial malignant hemispheric cerebral infarct, and more recently endovascular therapy for anterior circulating stroke. Also, special attention in management of vital systemic physiological variables, including oxygenation, blood pressure, temperature, and serum glucose. In line with this, the role of neuroanesthesiologists and neuro critical care in managing acute ischemic stroke become more prominent.