When acute ischemic stroke presents within the time window of 3–4.5 hours, it can be treated with IV tissue plasminogen activator (tPA) with the best outcomes.1 Stroke exhibits a decreasing trend in high-income countries, e.g., stroke has decreased to the third leading cause of death or disability in the United States. Robust economy, wide coverage of health insurance, better public health education, and effective health care policies are some important factors that have helped to curb disease progression. On the other hand, the incidence of stroke exhibits an increasing trend in low-income countries like Nepal.2 Due to the limited resources available, and outdated and ineffective public health policies in these nations, access to standard health care to all is nearly impossible. Stroke care units are an essential ingredient underpinning the safe implementation of stroke thrombolysis. Through this article, we have attempted to share our experience, as well as the results on acute stroke management.