Acute ischemic stroke (AIS) in Asian populations presents unique epidemiological characteristics and challenges, which are of great significance for grasping the effect of intravenous thrombolysis (IVT) in the treatment process. IVT has proven efficacy in improving outcomes for AIS patients, but its application in Asia faces distinct barriers, such as delays in diagnosis, differences in healthcare infrastructure, and variations in patient characteristics. This review examines recent research on the use of IVT for AIS in Asia, comparing findings with Western populations to identify both commonalities and disparities. We explore the current state of clinical practices, the challenges associated with treatment protocols, and the potential benefits of tailored therapeutic strategies. Additionally, the review highlights emerging trends and offers insights into how these factors may influence future research and clinical decision-making in the region.