In summary, organized, regionalized, systems for improving the early recognition and treatment of patients with acute stroke have been widely and successfully implemented. The PSC designation and JC certification program have been major drivers in this effort. These initiatives have resulted in dramatic increases in the use of intravenous tPA and improved patient outcomes. CSC and more complex, tiered models of stroke care delivery are being developed. While the JC has not yet launched a CSC certification program, several states have passed legislation or regulations to form stroke systems similar to the trauma model, with tiered levels of care and complex transfer rules. These systems will foster the use of endovascular intervention for ischemic and hemorrhagic stroke.