The Mid-America Regional Coordinating Center (MARCC) at Washington University School of Medicine spans the Midwestern states of MO, KS, and IL. Four high-volume stroke centers participate in MARCC including Barnes-Jewish Hospital (BJH) and St. Louis University Hospital (SLUH) in St. Louis, MO; St. Luke’s Hospital in Kansas City, MO; and the Order of St. Francis (OSF) Medical Center in Peoria, IL. Each of these medical centers is a tertiary care hub with large networks of referring hospitals, and have extensive experience participating in multi-center stroke trials. Thus, MARCC is a “Network of Networks.” Drawing from both rural and urban settings, MARCC hospitals admit almost 5,000 stroke patients per year, from diverse geographic locales, racial backgrounds, and socioeconomic strata.