Acute ischemic stroke is recognized as the third leading cause of death in the United States; improved treatments for management are important to reduce disability and death. The standard of care of acute stroke therapy has been reperfusion/recanalization of the occluded vessels using pharmacologic management, endovascular management, or a combination approach. Significant improvements have been made in the management with the use of endovascular therapy. This article reviews the literature on the endovascular and neurosurgical management of patients presenting with acute ischemic stroke and presents current evidence-based guidelines for endovascular or neurosurgical interventions outlined for management of ischemic stroke.