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Introduction: Though overall stroke incidence and mortality in U.S. is improving, little is known about the state of stroke care and trends over time in Asian-Americans.Methods: We abstracted clinical characteristics, treatment patterns, and outcomes from acute ischemic stroke admissions for Asian-American and White patients from 4/1/04-7/31/16 from 2,171 hospitals in Get With The Guidelines-Stroke. Multivariable regression models assessed association of Asian ethnicity and outcomes that adjusted for patient and hospital characteristics and NIHSS.Results: Study population (N=1,772,299) had 64,337 Asian-American patients (3.6%) and 1,707,962 White patients; mean age 72.4, 51.3% female. Asians had greater stroke severity than Whites (Table). After adjustment, Asians had greater stroke severity, higher in-hospital mortality, poorer functional recovery, received IVtPA less but had more serious and hemorrhagic complications, despite being more likely to receive IV tPA<60 min. After NIHSS adjustment, Asians had lower in-hospital mortality than Whites. Adjusted analyses of time trends revealed statistically significant increasing trend on IVtPA usage, decreased symptomatic ICH post-TPA, decreased in-hospital mortality, and improved QOC measures in both Asians and Whites. Both Asians and Whites had an increasing trend on IVtPA within 60 min, and Asians had significant larger increasing trend compared to Whites. Trend analyses also showed only Whites had decreasing trend on stroke severity and increasing trend on discharge home.Conclusions: This is the largest analysis of clinical and functional outcomes for Asian-American acute ischemic stroke patients. Asian-Americans have more severe ischemic strokes, worse functional outcomes, and receive less IVtPA than White patients. These findings warrant additional research, and more dedicated interventions towards improving clinical outcomes for Asian-American patients with acute ischemic stroke.