Globally, stroke is the second leading cause of death.1 The estimated 62 000 strokes that occur each year in Canada affect all age groups, from neonates to elderly people, with occurrence rates rising by age. The lifetime risk of overt stroke is estimated at one in four by age 80 years, and the lifetime risk of silent or covert stroke is likely closer to 100%. Stroke affects men and women equally and causes major social and economic burdens to society, with direct costs above $3 billion annually in Canada.2 Acute stroke and acute coronary syndromes have many similarities. Here, we review the diagnosis and management of acute ischemic stroke and compare its treatment with that of acute coronary syndrome, to help illustrate how the rapid relief of arterial occlusion and restoration of normal blood flow can save lives and prevent disability. This narrative review is based upon a critical appraisal of relevant clinical trials