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Background/Objectives While public education campaigns have successfully raised awareness about stroke symptoms and the importance of urgent medical evaluation, some patients with acute ischemic stroke continue to present to hospitals without ambulance transport. This study aimed to characterise the cohort of patients requiring reperfusion therapy who present to emergency departments without engaging ambulance services, as this group may represent an opportunity for targeted education.Methods A multicentre statewide retrospective cohort study was conducted in South Australia from January 2018 to January 2024. The study analysed data from all stroke admissions that received reperfusion therapy (thrombolysis or endovascular thrombectomy) and presented directly to hospital, excluding interhospital transfers and remote retrievals.Results Among 1,606 patients who presented directly to hospital and received reperfusion therapy, 86 (5.4%) arrived without ambulance transport. These patients were predominantly male (74.4% vs 55.7% in ambulance group, P < 0.001) and younger (mean age 65.5 vs 73.9 years, P < 0.001). This represented approximately 14.3 cases per year in a state with 1.8 million residents.Conclusions/Decision While non-ambulance presentations requiring reperfusion therapy are relatively uncommon, the findings identify a specific demographic who may benefit from targeted education about stroke symptoms and the importance of emergency transport.