急性缺血性卒中（AIS）是导致全球死亡和长期残疾的主要病因之一。再灌注治疗作为AIS的核心策略，主要包括静脉溶栓（IVT）和机械取栓（MT），通过恢复缺血区血流显著改善患者预后。近年来，该领域取得了一系列重要进展：①IVT药物从阿替普酶扩展至替奈普酶、瑞替普酶及重组人尿激酶原等新型药物；②影像技术的进步推动治疗时间窗不断拓展；③MT的适应证也从前循环大血管闭塞延伸至后循环及大核心梗死。此外，在直接取栓与桥接治疗的策略优化、再灌注损伤的防治以及人工智能辅助诊疗等领域同样取得了显著突破。然而，目前临床上仍面临时间窗把握、特殊人群治疗、医疗资源分布不均及并发症管理等挑战。本文系统综述了IVT、MT、联合治疗、特殊人群管理、技术创新等方面的最新进展，为临床实践提供参考。

Acute ischemic stroke (AIS) remains one of the leading causes of mortality and long-term disability worldwide. Reperfusion therapy, as the cornerstone of AIS management, primarily includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both of which significantly improve outcomes by restoring blood flow to the ischemic area. In recent years, significant advances have been made in this field: ① the repertoire of IVT agents has expanded beyond alteplase to include tenecteplase, reteplase, and recombinant human prourokinase; ② imaging advancements have continuously extended the therapeutic time window; and ③ the indications for MT have broadened from anterior circulation large vessel occlusions to include posterior circulation occlusions and patients with large core infarcts. Furthermore, notable progress has been achieved in optimizing direct MT versus bridging therapy, managing reperfusion injury, and integrating artificial intelligence into diagnosis and treatment. However, persistent clinical challenges include precise the determination of the time window, management for special populations, inequitable access to medical resources, and complication mitigation. This article systematically reviews recent advances in IVT, MT, combined therapy, management of special populations, and technological innovations, aiming to provide a reference for clinical practice.