Stroke services in Wales are experiencing serious shortcomings, according to a study.
The Royal College of Physicians' report says there are only two acute stroke units in Wales and there is no 24-hour clot-busting thrombolysis service.
The Stroke Association said this means outcomes are "much worse" for stroke sufferers in Wales.
A Welsh Assembly Government spokesperson said stroke services were a priority.
The report, called the Sentinel Stroke Audit, showed that of 75 acute units in England, Wales and Northern Ireland, only two are in Wales.
The audit also showed that staffing levels in Wales were lower.
The Stroke Association said that survivors were not getting the immediate specialist treatment needed.
However, the report also suggested that research into the condition had improved.
The association accepts that stroke services have been a priority in Wales for some time, with Health Minister Edwina Hart launching a 40-point action plan.
But it said that the findings showed more needed to be done.
Ana Palazon, director of the Stroke Association in Wales, said: "It is fantastic to see that such positive progress has been made in stroke research.
"But it is of great concern that there are no sites in Wales providing a 24/7 clot-busting thrombolysis service.
"This means that stroke survivors are not getting the immediate specialist treatment they need and are at risk of having much worse outcomes.
"Although Wales has made some much welcomed progress, and this must be recognised, more improvements still need to be put in place, and at a faster rate."
In Wales there are 2.9 qualified nurses per 10 stroke beds, compared to an average of 3.2 in all areas.
An average of 23% of all sites has staff in place for stroke specialist training, compared to 7% in Wales.
An assembly government spokesperson said: "Improving stroke services is a priority for the Welsh Assembly Government and care for stroke patients is getting better, although we accept there is more to do.
"In terms of acute care, 9am-5pm thrombolysis services are already available in eight of the 15 stroke centres across Wales, and after September this will rise to 14.
"Only some hospitals in the UK offer a round-the-clock service, but the roll-out of plans to deliver a 24/7 service in Wales is scheduled to commence in January 2011.
"We are developing new targets to improve early and later stage rehabilitation to help stroke patients get back to a normal life as quickly as possible."