Stroke care has evolved since the approval of tissue plasminogen activator for acute ischemic stroke but lags behind the treatment of other emergent conditions. Despite advancements in imaging techniques and intra-arterial interventions, traditional emergency departments struggle to optimize the use of intravenous thrombolytics for timely treatment and optimal patient outcomes. This chapter explores innovative approaches to ischemic stroke care, including the need for designated neurologic emergency departments staffed by stroke champions who autonomously administer thrombolytics to decrease door-to-needle times. It also highlights trials providing encouraging evidence for extended treatment windows and the use of tenecteplase as an alternative to alteplase. Furthermore, it explores the concept of neuroprotectives in post-thrombectomy recovery, focusing on the safety and efficacy of verapamil. These innovations offer promising avenues to improve the standard of care for those affected by acute ischemic stroke.