Periprocedural medical management is an important aspect in optimizing the outcome of patients who undergo endovascular treatment for acute ischemic stroke. Blood pressure, fluid hydration, and antithrombotics are some of the elements that need to be tailored carefully to the patient according to the patency of his or her cerebral vasculature, the extent of his or her infarct, and the potential for hemorrhagic transformation. This article reviews the medical care of acute stroke patients before and after endovascular therapy.