This article describes thrombolysis for acute ischaemic stroke as an emerging treatment modality. National clinical guidelines emphasized the need to identify acute stroke as a clinical priority and to develop protocols for the early assessment and treatment of stroke patients. Fast-track services developed in other clinical scenarios have proven successful and this article outlines the potential benefits of a fast-track service for acute stroke. The role of the clinical nurse specialist in stroke is central to this service; this role includes development and implementation of fast-track protocols in accident and emergency, rapid assessment for eligibility of thrombolysis and coordinating post-thrombolysis monitoring and acute stroke care.