Intravenous thrombolytic therapy for acute ischemic stroke with recombinant tissue plasminogen activator was approved to be under the application of Japanese health insurance on October 2005. To practice the high-quality therapy in stroke care unit and/or stroke unit, neurologist should play the role of a team leader and coordinator, working together with various medical staffs. The next neurologist in generation should have the mission and the passion for realizing the assured stroke center in all parts of country and seriously manage hyper-acute stroke patients in strained situation.