Acute ischemic stroke continues to be a leading cause of disability in adults and the fifth leading cause of mortality worldwide. In the past few years, acute ischemic stroke diagnosis and management has advanced by leaps and bounds, with the lengthening of the time window for intravenous tissue plasminogen activator and the establishment of endovascular stroke therapy. As a result of these changes, the focus today has shifted from proving efficacy to expanding indications and identifying all patients who may benefit from these therapies. In this pursuit, neuroimaging will continue to play a pivotal role, by shifting treatment paradigms from time-based to tissue-based. The quest to accurately determine the volume and function of salvageable brain has never been more important than now.