The demonstration that early thrombolytic therapy for acute cerebral infarction improves outcomes and the Food and Drug Administration (FDA) approval of intravenous recombinant tissue plasminogen activator (rt-PA) for acute cerebral infarction (see Chapter 7 ) stimulated establishment of rapid response stroke teams and certified stroke centers in the United States. The positive results from thrombolytic acute stroke clinical trials were exciting and not surprising given the known pathophysiology of acute cerebral infarction, the similarity of acute stroke to acute myocardial infarction (MI), and the demonstrated benefits of early myocardial reperfusion in acute MI. The need for rapid response teams in acute stroke is based on the evidence that thrombolysis with intravenous rt-PA is effective only within 3 h after stroke onset (1,2). The main risk in thrombolytic therapy for acute stroke is cerebral hemorrhage transformation of an infarct. Fortunately, the benefits of thrombolytic therapy in acute cerebral infarction overshadow the risks and the bleeding can be minimized by careful patient selection according to guidelines (see Chapter 18 ).