This lecture was recorded in the Grand Rounds of Emergency Medicine at Broward Health Medical Center in May 2018. The topic is Acute Ischemic Stroke and is presented by an expert group in Emergency Medicine, Neurology and Neurointervention Medicine. The lecture focuses on the updated 2018 Guidelines for the early management of patients with acute ischemic stroke. The results of two important stroke thrombectomy studies, the DAWN trial and the DEFUSE 3 studies, are covered in great detail. Discussion participants also discuss contradictions in the management of acute ischemic stroke, including thrombolytic therapy, studies evaluating their effectiveness, and skeptics who do not support this therapy.