A stroke system of care comprises a comprehensive, diverse, longitudinal system that addresses all aspects of stroke care in a coordinated manner. It includes the spectrum of stroke care from primary prevention to activation of emergency medical services, acute care, secondary prevention, rehabilitation and return to the community. Acute care for stroke can be initiated in acute stroke ready hospitals with subsequent transfer to either primary or comprehensive stroke centers. The attributes of an effective stroke system of care include coordinated care, customized to the local environment, able to make the best use of the resources available and that respects and maintains traditions of excellence. Care processes for patients with stroke can be improved through participation in certification and recognition programs such as the American Heart Association's Get With The Guidelines-Stroke program. The final aim of stroke systems should be to integrate prevention and treatment and promote patient access to the best evidence-based care.