Thrombolytic therapy for acute stroke has yet to achieve the far-reaching impact that has occurred in the treatment of myocardial infarction. A small minority of patients with stroke receive thrombolytic therapy, and delays in presentation and treatment account for much of the low rate of use. However, recent studies presented at the 26th International Stroke Conference [Fort Lauderdale, US; February 2001] show that the favourable experience seen with alteplase [t-PA] in large clinical trials can be replicated in clinical practice, including the community hospital setting. Other recent findings include evidence that thrombolytics can be administered 'safely' to very elderly patients and during telemedicine consultation and that pretreatment MRI*evaluation of patients can be performed without an excessive delay in treatment.