Systemic intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is a proven effective treatment in a certain category of patients with ischemic stroke during the first 4.5 hours after onset of this disease. Thrombolytic therapy (TLT) promotes the achievement of reperfusion in the cerebral ischemic portion, thus improving the patient's functional state. The results of international trials of TLP are presented and therapeutic strategies considered.