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.