Until recently, no clinically effective therapy for acute ischemic stroke has been available. Recent advances in the use of thrombolytic therapy for ischemic stroke appear promising in clinical care. As the use of thrombolytic therapy in acute stroke progress, emergency physicians (EPs) will become increasingly involved in its implementation. The EP must be cognizant of both prior and ongoing investigations in acute ischemic stroke therapy. To that end, this article reviews research in the field of thrombolytic therapy for acute ischemic stroke.