Intracranial neoplasms are currently considered a contraindication for intravenous (IV) thrombolysis in acute ischemic stroke (AIS) patients (1,2). Minimal data are available on the safety of IV thrombolysis for AIS in patients with preexisting intracranial neoplasm. We sought to determine the safety of IV recombitant tissue plasminogen activator (rtPA) in such patients through a retrospective hospital-based study. We retrospectively reviewed the medical records of patients who received IV rtPA for AIS from January 2006 to April 2014 at our tertiary academic medical center. All patients were treated based on the standard protocol adopted from the American Heart Association/ American Stroke Association within 4.5 h of AIS onset (2). Patients who received intra-arterial (IA) thrombolysis after IV rtPA were included. A subset of patients with definite intracranial neoplasms from this cohort was identified. Follow-up computed tomography (CT) or magnetic resonance imaging (MRI) within 24 to 36 h of IV rtPA administration and medical records were reviewed to determine the number of patients with symptomatic intracranial hemorrhage (sICH) in this subset. sICH was defined as intracranial hemorrhage (ICH) with an increase in National Institutes of Health Stroke Scale of at least 4 points (3). In addition, hemorrhage within the neoplasm was evaluated. Six hundred thirty-seven patients received full dose IV rtPA for AIS within the study period. Preexisting intracranial neoplasms were found in 13 of the 637 patients reviewed (2%). The demographics of the patients are outlined in Table 1. None of the 13 patients developed sICH or hemorrhage into the tumor after thrombolysis. To the best of our knowledge, our study is the largest on the safety of IV rtPA for AIS in patients with preexisting intracranial neoplasms. This study is also the first report, to our knowledge, of patients with intracranial neoplasm who received IV rtPA followed by IA thrombolysis with mechanical thrombectomy devices. Our study should be interpreted in light of several limitations. It is a single-center study with a low number of cases; in addition, we have no malignant neoplasm in our cohort and no generally valid conclusion can be drawn about the safety of IV thrombolysis in all grades of intracranial neoplasm. Our finding suggests that IV rtPA administration for AIS does not increase the risk of hemorrhage within the neoplasm in patients with preexisting benign intracranial neoplasm. Their listing in exclusion criteria for rtPA should be reconsidered to assure appropriate use of IV rtPA in this group of patients. We hope our study will encourage other centers to look into their data and study this further, so as to determine the actual risk of hemorrhage with rtPA in patients with intracranial neoplasms.