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Background and purpose: Rapid administration of IV tissue plasminogen activator (tPA) is crucial for better outcome in acute stroke treatment. While IV tPA is more frequently used in patients with minor stroke, the recognition of stroke and behavior of medical staffs in the emergency department (ED) may be different according to the severity of stroke symptoms. In this study, we investigated time to intervention is different according the stroke severity in stroke patients treated with IV tPA.Methods: We included consecutive patients who underwent IV thrombolysis during 1.5 year-period after IV tPA had been used regardless of stroke severity in the five university hospitals. Minor stroke was defined as a National Institute of Health Stroke Scale score <5. We compared various intervals from arrival at ED to treatment between patients with minor stroke and those with nonminor stroke. Delayed treatment was defined as door-to-needle time over 40 min.Results: During the study period, a total of 356 patients who admitted to the emergency department received IV tPA treatment. Median door-to-needle time was significantly longer in the minor stroke group than the non-minor stroke (43 min, interquartile range [IQR 35 - 54 vs. 37 min, [IQR 30 - 46], p<0.001). Among various steps to intervention, door-to-notification time (7 min [IQR 4 - 12] vs. 5 min [IQR 3 - 8], p<0.001) and notification-to-imaging time (12 min [IQR 8 - 17] vs. 10 min [IQR 6 - 15], p=0.033) were significantly longer in the minor stroke group than the non-minor stroke group. However, image-to-needle time was not significantly different between the groups. Among 356 patients, door-to-needle time was over 40 min in 157 patients (44.1%). After adjusting age, sex, and presence of alarm system, minor stroke was associated with the delayed treatment (OR 2.48; 95% confidence interval [1.49 - 4.16], p=0.001) in the multivariable analysis.Conclusions: Door-to-needle time was longer in patients with minor stroke than those with non-minor stroke, which was mainly ascribed to delayed door-to-notification time and notification-to-image time. Efforts to improve stroke recognition and medical professional’s behavior at triage are required in patient with minor stroke.