China is one of the countries with highest incidence of stroke in the world. However, the rate of intravenous thrombolysis for ischemic stroke is extremely low in China, which is related to traditional triage system and inefficient management, the potential of hemorrhagic transformation, and narrow therapeutic time window. In order to improve the clinical implementation of thrombolysis, it is necessary to look at the related issues and to refine the therapeutic protocol according to the international experiences. Careful screening of eligible patients is crucial to reduce the rate of symptomatic intracranial hemorrhage. The advanced penumbral imaging is believed to enhance patient selection and extend the therapeutic time window. In addition, endovascular therapy is increasingly utilized to raise the recanalization rate. All these measures would enhance the improvement of the clinical management for acute stroke patients.