OBJECTIVES: Acute ischemic stroke (AIS) is a major public health concern and among the leading causes of death and disability in western societies. The management of AIS and its long term evolution in the USA and Canada was assessed through a literature search. METHODS: Medline was searched for the time period 1999-2010 to identify stroke cohorts and registries containing relevant data on AIS management and/or long term evolution. Subsequently, a ranking process was used to identify and select the most relevant references. RESULTS: A total of 680 references were retrieved (581 USA and 99 Canada). Publications from more than 80 distinct cohorts/registries/databases were analyzed and a final selection led to the identification of 43 publications for the USA and 25 for Canada. IS proportion among all strokes ranged from 43%-90% in hospital cohorts. 24%-33% of  all stroke patients arrived at the hospital within 3 hour of symptom onset and rt-PA treatment was received in 1.1%-14% of all AIS patients. The majority of patients, i.e. 82%-100% underwent a CT/MRI scanning.  In general, hospital setting and care characteristics were poorly documented and relatively few quality indicators of stroke management were targeted. For long term evolution outcomes, mortality was well documented (5%-17% 1 month, 17%-35% 3 months, 30%-37% 3 years, 37%-54% 5 years). AIS recurrence and cardiac events were described in few, mainly USA, studies. There was a lack of data on disability (modified Rankin Scale) evolution after 3 months and studies on depression were scarce. CONCLUSIONS: Hospital setting, characteristics of care, and  long term evolution of disability are poorly documented in American and Canadian registries. New cohort and registry studies should specifically aim to generate real life data on ischemic stroke care that influence short and long-term clinical and associated economic outcomes.