OBJECTIVES: To evaluate the management of ischaemic stroke (IS) patients enrolled in the Japan Stroke Databank (JSD) from 2000 to 2007. METHODS: JSD is an observational registry of patients who experienced a stroke event, collecting patient information provided by over 80 Japanese hospital departments. Data included demographics, time to admission, medical history, stroke type diagnosis, imaging, treatment, Japan Stroke Scale (JSS), NIH Stroke Scale (NIHSS) and the modified Rankin Scale (m-RS). Logistic regression model was used to identify predictors of m-RS 0-1 at discharge. RESULTS: Of the 47,782 stroke patients, when excluding for transient ischemic attack (TIA) cases, 15,282 (32%) were ischaemic stroke cases with NIHSS evaluation at hospitalization and at discharge and with m-RS assessment at discharge. Average age was 69.7 years (±10.6) and 64% were males. Patients who were admitted to hospital at a later time window from onset had a lower m-RS score (0-1) at admission (12%, 13%, 15% and 17% for patients admitted at 0-3, 3-4.5, 4.5-8 and 8-24 hours , respectively). However, patients admitted at later time-windows had worse disability at discharge (within patients admitted with m-RS 0-1, 53% vs. 48% had m-RS 0 at discharge depending if admitted before or after 3 hours after onset). 57% of patients arrived after 3 hours and only 5CONCLUSIONS: This study demonstrates that despite the availabilities of therapies for acute ischemic stroke there is still a high unmet need to reduce severity at discharge for these patients as only 5.8 % of patients receive thrombolytic therapy.