Aim: Ischemic stroke remains a leading global cause of morbidity and mortality, emphasizing the need for timely treatment strategies. This study aimed to develop a machine learning model to predict clinical outcomes in ischemic stroke patients undergoing Alteplase therapy, thereby supporting more personalized care. Methods: Data from 457 ischemic stroke patients were analyzed, including 50 demographic, clinical, laboratory, and imaging variables. Five machine learning algorithms, k-nearest neighbors (KNN), support vector machines (SVM), Naïve Bayes (NB), decision trees (DT), and random forest (RF), were evaluated for predictive accuracy. The primary evaluation metrics were sensitivity and F-measure, with an additional feature importance analysis to identify high-impact predictors. Results: The Random Forest model showed the highest predictive reliability, outperforming other algorithms in sensitivity and F-measure. Furthermore, by using only the top-ranked features identified from the feature importance analysis, the model maintained comparable performance, suggesting a streamlined yet effective predictive approach. Conclusion: Our findings highlight the potential of machine learning in optimizing ischemic stroke treatment outcomes. Random Forest, in particular, proved effective as a decision-support tool, offering clinicians valuable insights for more tailored treatment approaches. This model's use in clinical settings could significantly enhance patient outcomes by informing better treatment decisions.