Pharmacological and device-induced reperfusion therapies have demonstrated increasingly positive outcomes regarding both reperfusion efficacy and 90-day functional outcomes after acute ischemic stroke. However, presently, only a minority of patients are eligible for these treatments. Less than 10 % of all ischemic stroke patients receive intravenous thrombolysis in most centers and it has been projected that only approximately 7-15 % of ischemic stroke patients are eligible for acute endovascular intervention. Making these effective therapies safely available to a much larger number of patients is critical for expanding the benefits of acute ischemic stroke treatment. In this article, we summarize the key results from the clinical trials, challenges, and exciting novel opportunities to increase patient eligibility for these therapies as well as for better outcomes for stroke patients.