Acute Ischemic Stroke (AIS) remains a leading cause of death and long-term disability worldwide, where every minute is critical in determining patient outcomes. Timely thrombolytic therapy has transformed the management of AIS, significantly improving functional recovery when administered appropriately. However, clinical decisions surrounding thrombolysis often involve balancing benefits and risks across diverse patient scenarios. This National Panel Discussion brings together leading stroke experts to explore the current paradigm of thrombolysis in AIS, with a special focus on the role of alteplase and evidence-based decision-making in real-world clinical practice. Through expert insights and interactive discussions, the session aims to equip clinicians with practical strategies to optimize acute stroke care and improve patient outcomes.