Purpose: This retrospective study aimed to investigate the factors delaying the arrival of acute ischemic stroke patients to the emergency department in a tertiary care hospital in India. Methodology: The study examined demographic, clinical, and social factors across four key domains: patient characteristics, clinical presentation, healthcare system factors, and sociocultural factors. Data were collected using a standardized tool and analyzed using descriptive statistics. Results: The study found that most patients were between 51-70 years old, with a higher proportion of male patients (55.6%). The most common comorbidities were the combination of Diabetes Mellitus and Hypertension (31.9%) and Hypertension alone (13.9%). Various stroke symptoms were evaluated, highlighting the diverse clinical presentation of acute ischemic stroke. The majority of patients had minor (46.5%) or moderate (45.1%) stroke severity based on the NIH Stroke Score. The mean time to reach the first doctor (16.95 hours) and the emergency department (19.08 hours) was considerably longer than the recommended window for effective stroke treatment. The use of ambulance services was alarmingly low (1.4%), and most patients (81.9%) lived more than 15 kilometres from the hospital. The lack of awareness regarding stroke symptoms (39.6%), the critical time window for effective treatment (13.2%), and advanced therapies like thrombectomy (0%) were observed. Conclusion: The study's findings highlight the need for targeted interventions to raise public awareness about stroke symptoms, the importance of timely hospital arrival, and the availability of advanced treatment options. Strengthening primary care, enhancing emergency 11 medical services infrastructure, establishing dedicated stroke units, and leveraging telemedicine technologies are essential strategies to reduce pre-hospital delay and improve stroke outcomes in India. Future research should evaluate the effectiveness of educational interventions and healthcare policies in reducing pre-hospital delays and improving stroke outcomes. Keywords: Acute ischemic stroke, pre-hospital delay, emergency department, stroke awareness, healthcare system factors, sociocultural factors.