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Objective: To present the main advances and projections related with ischemic stroke management. Development: This article look at some recent aspects considered in specialized journals about: 1) Definition of stroke types, 2) Genetic risk factors of ischemic stroke, 3) Neuroimaging paradigm in ischemic stroke, 4) Telemedicine for stroke (telestroke), 5) Antithrombotic use (oral dual antiagregante therapy, periprocedural management of antithrombotic, prevention with direct action oral anticoagulants, extension of thrombolytic time to 4.5 hours after onset), 6) Evolution of approach regarding endovascular techniques, 7) Stem cells administration for brain infarction, 8) Therapies for malignant hemispheric brain edema, 9) Blood pressure levels regulation in stroke, and 10) Identification of pharmacological intervention (Selective serotonin reuptake inhibitors) for aid in motor recovery. Conclusions: A review was carried out about main advances and trends for research and clinical practice of ischemic stroke. The consideration of implementation limiting factors is vital for perfection of stroke patient management. For the implementation of this advances are required an increase consciousness and public education about stroke, protocols improvement for stroke centers, development of stroke certification process and stroke capabilities, and economic and legislative support. [ABSTRACT FROM AUTHOR]