Many case series showed local intraarterial thrombolysis using urokinase was effective treatment for acute ischemic stroke, but it was performed in the limited area because its outcome largely depends upon the manpower and facility of the each stroke center. Thrombolysis has not been in use world-wide, until a large randomized control study revealed intravenous thrombolysis using tissue plasminogen activator (t-PA) is a safe and effective treatment for ischemic stroke. The clinical trial also showed that thrombolysis significantly increases the incidence of fatal hemorrhage and the development of effective methods for selection of proper candidates is warranted. New advanced MR technology including diffusion and perfusion weighted images may be able to identify ideal candidates for thrombolytic therapy. Here the author review data from clinical trials and current treatment options for patients with acute ischemic stroke.