en Neurology Review Article Review Article <div style="text-align: justify;"><strong>Context</strong>: Based on current literature, there is no consensus regarding the proper emergency management of Pediatric Acute Ischemic Stroke (P-AIS). In other words, there are lots of considerable controversies in this regard. Therefore, the current review was conducted to provide a more comprehensive discussion on this topic.&nbsp;<br> <strong>Evidence Acquisition</strong>: The search was conducted using the terms &ldquo;pediatrics&rdquo;, &ldquo;stroke&rdquo;, and &ldquo;recombinant tissue plasminogen activator&rdquo; in the PubMed database. English papers on the management of P-AIS published after 2000 were selected. An expert panel performed a critical appraisal to summarize the findings and make them applicable. Finally, the extracted data were categorized under proper subheadings, and the manuscript was prepared.<br> <strong>Results</strong>: The related papers provided limited evidence on this topic. All extracted findings were categorized as follows: etiology and the underlying diseases, clinical presentations, diagnosis, management (thrombolytic therapy and thrombectomy), and outcome.<br> <strong>Conclusions</strong>: Although thrombolytic therapy is recommended in P-AIS, most cases are diagnosed outside the therapeutic window, so P-AIS is practically impossible, and they are candidates for mechanical interventions. On the other hand, the proper device may not be available to fit the size of the younger children&rsquo;s vasculature.</div> Cerebrovascular disorders, Disease management, Pediatrics, Stroke, Emergency management 47 52 http://jpr.mazums.ac.ir/browse.php?a_code=A-10-280-2&slc_lang=en&sid=1 Shaghayegh Shahmirzaei sh-shahmirzaei@alumnus.tums.ac.ir 10031947532846006272 10031947532846006272 No Multiple Sclerosis Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fazeleh Majidi f-majidi@@alumnus.tums.ac.ir 10031947532846006273 10031947532846006273 No Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohamed Elfil mohamed.elfil@yale.edu 10031947532846006274 10031947532846006274 No Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA. Mohamed Eldokmak mohamed.eldokmak@yale.edu 10031947532846006275 10031947532846006275 No Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA. Ali Reza Baratloo alirezabaratloo@yahoo.com 10031947532846006276 10031947532846006276 Yes Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.