Abstract: Despite the existence of numerous therapeutic targets for acute ischemic stroke in theory, improving the blood supply to the brain comes first in clinical practice. Thrombolysis constitutes the only approved therapy for acute ischemic stroke. However,　only 1.6% of the patients with acute ischemic stroke received thrombolytic therapy within the time window in China.　And the question raises: what else could we do for non-thrombolysis patients after acute cerebral infarction right the first time?　In clinical practice, we found that the key to treat the patients with ischemic cerebrovascular disease is still to improve and recover cerebral perfusion, and the cerebral collateral circulation plays an important role right the first time.

Key words: stroke, brain ischemia, reperfusion, collateral circulation