This review discusses the latest literature on intravenous (IV) rt-PA therapy, focusing on its effectiveness in mild cases and elderly patients, post-treatment for cases without recanalization, and the effects of the approved dose of 0.6 mg/kg in Japan. Key findings include: 1. **Mild Cases**: Studies from Canada and Germany show that rt-PA is safe and effective for mild cases with NIHSS scores below 5, with low rates of symptomatic intracerebral hemorrhage and improved outcomes at 90 days. 2. **Elderly Patients**: A study by Mateen et al. found that rt-PA did not improve outcomes in patients over 90 years old, with a high mortality rate and significant unsymptomatic intracerebral hemorrhage. 3. **Post-Treatment for Cases Without Recanalization**: Kim et al. reported that combining IV rt-PA with intra-arterial thrombolysis (IA) significantly improved recanalization rates and functional outcomes in cases where recanalization was not achieved after IV rt-PA alone. 4. **Japanese Experience with 0.6 mg/kg Dose**: Toyoda et al. analyzed data from 600 patients in Japan and found that this dose was effective but had limitations, particularly in cases of internal carotid artery occlusion. The study also noted an increase in MRI, DWI, MRA, and other diagnostic techniques following the approval of rt-PA. 5. **Other Topics**: Research has explored the use of brain protection drugs like edaravone to prevent intracerebral hemorrhage during rt-PA administration, the role of susceptibility vessel sign in predicting early recanalization, and the importance of the number of stroke physicians in hospitals for effective rt-PA treatment. Overall, the review highlights the expanding use of IV rt-PA, the need for advanced imaging techniques, and the importance of optimizing treatment strategies to improve outcomes in various patient populations.This review discusses the latest literature on intravenous (IV) rt-PA therapy, focusing on its effectiveness in mild cases and elderly patients, post-treatment for cases without recanalization, and the effects of the approved dose of 0.6 mg/kg in Japan. Key findings include: 1. **Mild Cases**: Studies from Canada and Germany show that rt-PA is safe and effective for mild cases with NIHSS scores below 5, with low rates of symptomatic intracerebral hemorrhage and improved outcomes at 90 days. 2. **Elderly Patients**: A study by Mateen et al. found that rt-PA did not improve outcomes in patients over 90 years old, with a high mortality rate and significant unsymptomatic intracerebral hemorrhage. 3. **Post-Treatment for Cases Without Recanalization**: Kim et al. reported that combining IV rt-PA with intra-arterial thrombolysis (IA) significantly improved recanalization rates and functional outcomes in cases where recanalization was not achieved after IV rt-PA alone. 4. **Japanese Experience with 0.6 mg/kg Dose**: Toyoda et al. analyzed data from 600 patients in Japan and found that this dose was effective but had limitations, particularly in cases of internal carotid artery occlusion. The study also noted an increase in MRI, DWI, MRA, and other diagnostic techniques following the approval of rt-PA. 5. **Other Topics**: Research has explored the use of brain protection drugs like edaravone to prevent intracerebral hemorrhage during rt-PA administration, the role of susceptibility vessel sign in predicting early recanalization, and the importance of the number of stroke physicians in hospitals for effective rt-PA treatment. Overall, the review highlights the expanding use of IV rt-PA, the need for advanced imaging techniques, and the importance of optimizing treatment strategies to improve outcomes in various patient populations.