Background & Objectives: The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on clinical practice worldwide with severe consequences for acute stroke care. We aimed to evaluate our institution’s experience and measure the impact of the COVID-19 pandemic on acute stroke care in a single-center in Varna, Bulgaria. Methods: We conducted a retrospective study, including all the patients presented with acute stroke to a tertiary care referral center for neurological disorders in Eastern Bulgaria. We compared the data aboutstroke incidence, patient characteristics, treatment details, logistics, mortality rate, and general qualitative parameters in two periods - July to September 2020 (COVID) and the corresponding period in 2019 (pre-COVID). Results: There was a 17.29% increase in all admissions in the COVID period compared with 2019, as there were more patients with firstever ischemic stroke (p=0.031) and more severe cases in comatose state during admission (p=0.0001). During the pandemic, the time from onset to arrival in the hospital was significantly prolonged from 231 ± 233 minutes in 2019 to 615 ± 1179 minutes (p=0.0001), intravenous thrombolysis rates were decreased (p=0.014), mortality from acute ischemic stroke was two-fold higher, and stroke-survivors had a higher disability (p=0.0001). A decrease in the rehabilitation assessment was noted (p=0.002), while door-to-needle time for thrombolysis and other major qualitative parameters of acute stroke care did not significantly differ. Conclusion: During the COVID pandemic, we found an increase in stroke cases and a substantial delay from stroke onset to hospital presentation. These logistics changes could be one reason that led to more severe cases with worse functional outcomes and higher mortality rates.