Ischemic stroke is a leading cause of death and disability worldwide. Recent advances in acute treatment provide hope that the impact of this disease will be reduced. Rapid assessment for large vessel occlusion is now a key element in acute stroke care given advances in endovascular therapy. Because access to acute therapies is limited, development of systems of care to triage appropriate patients to specialized centers is essential. Acute hospitalization management requires multiple strategies including initiation of secondary prevention measures. In addition to preventing further stroke, physicians can also improve long-term survival by preventing the complications of stroke in the hospital and ensuring longitudinal poststroke care and rehabilitation following discharge.