Background: Ischemic stroke (IS) is defined as a focal neurologic deficit of sudden onset and of presumed ischemic origin that lasts at least 24 hours and is not associated with hemorrhage on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. About 87% of strokes are ischemic, the rest being hemorrhagic. Bleeding can develop inside areas of ischemia, a condition known as "hemorrhagic transformation" (HT). Definitive therapy within the first few hours is aimed to removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). Aim of the Work: was to correlate the safety of recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients in Egypt. Subjects and Methods: A number of case series of patients with AIS who were treated at Stroke Units of Al-Azhar University Hospitals and Almaadi Military Hospital over a period of 1years within a time window were reported. Results: we observed a statistically significant correlation between AIS patients who were treated by thrombolysis in time window and vascular risk factors and many important infrastructure-logistic factors. Conclusions: It could be concluded that thrombolytic therapy is a good standard treatment in time window but many barriers in developing countries were found.