German Society of Neurology's stroke-unit concept includes a specialized stroke-unit team and advanced monitoring facilities in the early phase of stroke. Our aim was to evaluate the effectiveness of this semi-intensive stroke-unit (SI-SU) concept as compared with conventional care (CC) for patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Over a 20-month period starting in March 2001, 755 patients with AIS or TIA were treated under SI-SU (n = 393) or CC (n = 362) conditions within an observational study. All patients were admitted within 24 h after symptom onset. Patients' outcomes were assessed after 1 year of follow-up, considering concept of care, patients' clinical characteristics, and comorbid conditions. The CC patients were older and had a greater frequency of atrial fibrillation. 1 year after ischemia, 715 patients (94.7%) could be reinvestigated. Mortality and disability (mRS > 2) were lower in the SI-SU group compared with the CC group (15.6% vs. 27.0%, P < .05; 33.9% vs. 39.8%, P = .16, respectively). In multivariate analysis, AIS patients (n = 453) treated under SI-SU had significantly lower 1-year mortality and disability compared with the CC-treated patients (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.27-0.83 and OR: 0.44, 95% CI: 0.22-0.87; respectively). For TIA patients, (n = 262) SI-SU care showed no significant effect in any outcome variable. Our prospective study provides evidence that SI-SU with advanced early monitoring and treatment for patients suffering from AIS results in a better outcome 1 year after ischemic stroke if compared with conventional care.