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On the basis of selected publications from the past 12 months, current developments and innovations in the prevention and treatment of stroke are presented. For primary prevention, the combination of an ACE inhibitor and a calcium antagonist has proved to be more effective than the combination of an ACE inhibitor with a diuretic. For patients with diabetes mellitus low-dose ASA is not effective for the primary prevention of macrovascular events. Aggressive treatment of diabetes mellitus type II reduces microvascular events but does not lead to a reduction in heart attack, stroke or vascular mortality. The safety and efficacy of systemic thrombolysis with rt-PA has also been demonstrated in the expanded time window of 3 to 4.5 hours after ischaemic stroke. There are indications that a comedication with omeprazol can lead to a reduction of the effects of clopidogrel. In patients with atrial fibrillation, those with contraindications against an oral anticoagulation, or those who reject the latter therapy, the combination of clopidogrel with ASA is superior to an ASA monotherapy. However, the combination therapy of ASA with clopidogrel is associated with a markedly higher bleeding risk in the secondary prophylaxis of stroke. On the basis of long-term results, carotid endarterectomy is the treatment of first choice in cases of symptomatic > 70% carotid stenosis and can be performed either under local anaesthesia or under general anaesthesia.