The recent impact of improvement in the treatment of acute ischemic stroke (AIS) resulted in a reduction in death and an improvement in outcomes, especially in developed countries. The results of groundbreaking positive randomized controlled trials have revealed that patients with large vessel occlusion (LVO) treated with endovascular mechanical thrombectomy (EVMT) compared with standard treatment are associated with significantly higher functional outcomes. Current evidence also confirmed that the early positive outcomes of EVMT continue to persist for stroke patients with LVO even if the mechanical perfusion therapy extends up to 24 hours of symptoms, including those with wake-up stroke. The evidence suggests that for every two patients treated with EVMT, one patient can be saved, which is the highest evidence in the medicine surpassing acute myocardial infarction and other acute lifesaving therapies. Based on this evidence, local, national, and international organizations have updated the guidelines in the treatment of AIS, which have remarkably strengthened the process, pathways, and standards for acute ischemic stroke management in developed countries. However, not much progress has been made in developing and third-world countries, including Bangladesh, for stroke therapies because of cost and affordability, and there are no third-party payers. Most recent trials have further identified that stroke patients with LVO and a large core volume can be treated with endovascular perfusion therapy in conjunction with standard treatment, which is associated with significantly better compared to standard treatment only. Recent trials have also demonstrated that stroke patients undergoing EVMT with or without thrombolytic have equal functional outcomes. Additional evidence suggests that non-disabling stroke patients treated with dual antiplatelet agents have equal functional outcomes with less bleeding risk compared to intravenous thrombolysis. This evolving evidence has provided us with opportunities to simplify the algorithm and treatment of acute ischemic stroke, which not only will cut down time by eliminating unnecessary steps and redundant therapies but also will reduce healthcare costs and improve global access, especially in countries where patients bear the costs. In this review, the author presents real-life stroke patients treated based on recent evidence and provides a simple and swift algorithm that potentially may reduce the time for perfusion therapy and make the treatment affordable globally, including in developing countries like Bangladesh.