Thrombolytictherapy for stroke signals a breakthrough, through clots and nihilistic attitudes. Although a systematic approach to stroke care as exemplified by stroke units has been shown to improve outcomes,1recombinant tissue-type plasminogen activator (rt-PA) is the first drug to make a demonstrable difference to stroke. Brott provides the facts, and Riggs offers the context. Under the strict conditions of the National Institutes of Health Study, little doubt exists that rt-PA therapy offers a benefit, but at the risk of death from rt-PA in a ratio of 4:1. This choice should be offered to as many patients as possible, provided the following are available: • Medical expertise in the diagnosis and management of acute stroke. • High-quality imaging and interpretation. • Facilities and expertise to monitor blood pressure, diagnose intracranial hemorrhage, and manage the consequences. A center that fulfills these criteria would also be able to participate in clinical