One of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic non-neurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are made.