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Background and Aims: Recombinant tissue plasminogen activator (rt-PA) is often withheld for mild or rapidly improving acute ischemic stroke. The aim of this study is to determine risk factors for poor outcomes in such cases.Method: This study included 772 consecutive acute ischemic stroke patients from the Fukuoka Stroke Registry who did not receive rt-PA therapy because of mild or rapidly improving symptoms. Logistic regression analysis was performed to determine the predictors of poor outcomes (modified Rankin Scale 3-6 at 3 months after onset).Results: Eighty-six patients (11.1%) showed a poor outcome. Compared to patients with a good outcome (n=686), those with a poor outcome were older (78±10 vs. 68±13 years, p<0.0001) and had higher initial NIH Stroke Scale (quartile value 3-4 vs. 1-2, p<0.0001). A poor outcome was more frequent among patients with chronic kidney disease (10.4% vs. 4.8%, p=0.0293), atrial fibrillation (24.4% vs. 15.0%, p=0.0252), cortical symptoms (20.9% vs. 8.6%, p=0.0003), limb paralysis (34.8% vs. 23.3%, p=0.0190), and branch atheromatous disease (15.1% vs. 3.6%, p<0.0001). In multivariate analysis, age (every 1 year, odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10, p<0.0001), chronic kidney disease (OR 1.78, 95% CI 1.11-2.83, p=0.0151), cortical symptoms (OR 2.27, 95% CI 1.19-4.21, p=0.0125), and limb paralysis (OR 1.67, 95% CI 1.04-2.66, p=0.0312) were positively associated with a poor outcome.Conclusion: In patients with older age, chronic kidney disease, cortical symptoms, or limb paralysis, rt-PA administration should be considered even for mild or rapidly improving stroke.