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Background Rapid reperfusion is critical in large vessel occlusion (LVO) stroke, with functional outcomes declining as treatment delays increase. Parallel activation systems may accelerate endovascular therapy (EVT) workflows. We evaluated the diagnostic performance and workflow impact of an institutional LVO paging protocol activating the endovascular team, anesthesia and critical care team triggered by a pre-arrival Stratified Los Angeles Motor Scale (SLAMS) ≥4, or the presence of cortical signs or NIHSS ≧10 during pre-imaging triage.Methods We performed a retrospective single-center study of consecutive stroke activations at a large urban thrombectomy-capable stroke center. Early LVO code activation was defined as activation prior to CT angiography (CTA) acquisition. Diagnostic performance for detecting radiographically confirmed LVO was assessed among 2,035 stroke activations. Workflow time metrics and clinical outcomes were analyzed among EVT-treated patients, comparing early activation with regular stroke code. Multivariable regression models adjusted for age, baseline NIHSS, and intravenous thrombolysis.Results Among 2,035 stroke activations, 271 patients had confirmed LVO. Early LVO code activation occurred in 384 cases. Diagnostic performance demonstrated sensitivity 70.5%, specificity 89.1%, positive predictive value 49.7%, negative predictive value 95.2%, with likelihood ratios of 6.45 (positive) and 0.33 (negative). Among 170 EVT-treated patients, early activation was associated with significantly faster workflow times, including door-to-CT (14 vs 25 min), door-to-CTA (20 vs 31 min), door-to-puncture (91 vs 127 min), door-to-first-pass (106 vs 155.5 min), and door-to-reperfusion (122 vs 171 min; all p<0.01). Adjusted analyses confirmed significant reductions in door-to-puncture (−29 min) and door-to-reperfusion (−49 min). Functional outcomes at 90 days were similar between groups, though analyses were underpowered.Conclusions Early activation of an LVO paging protocol demonstrates strong diagnostic performance and substantially accelerates EVT workflow times. Parallel mobilization of neurointerventional resources may represent an effective systems-based strategy to optimize acute stroke care.Disclosures A. Pinheiro: None. K. Perlman: None. M. Zavala: None. A. Joshua: None. F. Ayala: None. J. Farraye: None. T. Shigematsu: None. C. Kellner: None. J. Fifi: None. Z. Hickman: None. H. Shoirah: None.