Background <p>Treatment of patients with acute stroke requires hospitalization. Cooperation of neurologists, neuroradiologists, intensive care physicians, internists, and cardiologists is required to achieve best possible outcome.</p> Objective <p>A&#xa0;summary of the current recommendations for stroke treatment is provided.</p> Methods <p>This update is based on the S3&#xa0;guidelines and incorporates additional results of the latest clinical studies; pubmed.gov was used as the database.</p> Results <p>Computed tomography (CT) or magnetic resonance imaging (MRI) are essential to differentiate between ischemic and hemorrhagic stroke. The S3&#xa0;guideline recommends thrombolysis within 4.5 h after the onset of symptoms, while mechanical thrombectomy for large vessel occlusions may be indicated up to 24 h after stroke onset in certain cases. Therapy should be initiated for an internal carotid artery (ICA) stenosis of at least 50%.</p> Conclusion <p>Thrombolysis, mechanical thrombectomy, and the treatment of ICA stenosis are the three cornerstones of acute stroke treatment.</p>