Acute ischemic stroke is considered a potentially treatable disease because of the increasing development of pathways of care and endovascular treatment. The selection of patients for treatment is evolving accordingly with the randomized controlled trials (RCTs) extending the limits of beneficial treatment and determining a crucial shift from a time-based concept to a tissue-based concept. Neuroradiology techniques are crucial for patients’ selection and both computed tomography (CT)-based and magnetic resonance imaging (MRI)-based techniques are widely employed aiming to assess the occlusive pattern and the core–penumbra ratio. Some information might be provided by a careful examination of the non-contrast computed tomography (NCCT) study and the main neuroimaging issues are summarized in a pragmatical view. The current recommendations on acute stroke treatment are presented, in particular about revascularization therapies.