The recombinant tissue plasminogen activator (tPA) alteplase is approved for use as intravenous thrombolysis (IVT) in patients with ischemic stroke within 3 hours after onset of stroke symptoms. American Heart Association/American Stroke Association (AHA/ASA) guidelines have expanded the window of treatment with alteplase to 4.5 hours after stroke onset for selected patients (for information on selection criteria, see Quick Lesson About … Stroke: Drug (Thrombolytic) Therapy).The American College of Emergency Physicians and the American Academy of Neurology endorse the use of the expanded window; however, use of tPA in the 3–4.5 hour window has yet to be approved by the U.S. Food and Drug Administration (FDA). Early neurosurgical intervention may be beneficial for patients with hemorrhagic stroke.