Intravenous thrombolysis is still one of the most effective therapies for patients with acute ischemic stroke. Recombinant tissue-type plasminogen activator (rt-PA) has been approved for clinical use since 2002 in Taiwan. Previously, Taiwan Stroke Society has published the guidelines of intravenous thrombolysis for acute ischemic stroke patients in 2008 and 2013, respectively. Enhanced effort to increase intravenous rt-PA treatment for acute ischemic stroke patients in Taiwan can be observed, and the rate of treatment reached to 4-5% in recent years. However, the indication and treatment time of intravenous thrombolysis have been expanded recently. To provide the evidence-based recommendations, and standardize intravenous thrombolysis for acute ischemic stroke, the Taiwan Stroke Society Guideline Consensus Group revised the guideline. The guideline contains 5 issues, including intravenous rt-PA treatment for onset to needle time more than 3 hours, age over 80 years, mild or rapidly improving symptoms, pre-stroke use of anticoagulants, and probably endovascular thrombectomy for patients with large vessel occlusion.