〔Abstract〕 The clinical date of 146 patients with wake-up strokes(WUS) were retrospectively analyzed. Reperfusion therapy in 62 patients with WUS was performed according to the mismatch of cerebral MRI DWI/FLAIR or PWI/Core Infarct Volume. The scores of 24 h NIHSS and 90 d mRS in reperfusion were lower than those of the 84 patients in WUS non-reperfusion. The incidence symptomatic intracranial hemorrhage and mortality did not increase. Reperfusion therapy for WUS patients under the guidance of multimodal magnetic resonance imaging is safe and effective.