Introduction: Stroke is the leading cause of chronic disability and third-leading cause of mortality in Hawaii. State incidence of stroke is lower (2.9% to 3.4%) but mortality is higher (70.3:100,000) compared to the rest of the country (58.1:100,000). Access to comprehensive acute stroke care is complicated by geographical restrictions including topography and isolation between islands and also socioeconomic factors such as cost of living. The Queen’s Medical Center (QMC, Honolulu, Oahu, HI) is the sole comprehensive stroke center in the state. Hypothesis: Access to comprehensive stroke care and thrombectomies will be negatively correlated with both travel time and increased geographical barriers. Methods: Retrospective review of records from QMC between January 2021 to June 2023 identified 405 patients with an acute stroke and underwent thrombectomy. Patient zip codes were used to create a heat map identifying locations of patients receiving thrombectomy. Another heat map was made for all acute stroke cases using public health data. An index was created to determine travel time from zip code to QMC. Thrombectomy and acute stroke versus travel time was performed using generalized linear models. Results: GIS-generated heat maps demonstrate a difference in care opportunities between zip codes, identifying areas with highest incidence of acute stroke associate with lower rates of thrombectomy procedures. Island barriers create the highest differences in acute stroke cases versus thrombectomy procedure. Regression analysis demonstrated marked negative correlation in comparison between thrombectomies versus acute stroke cases with respect to travel time. Conclusions: Healthcare providers in Hawaii face an increased challenge with respect to providing care due to natural geography that extending the time to comprehensive stroke treatment. Hawaii is acutely aware of the unique challenges and the results of this study are an initial phase in providing a framework for modified statewide acute stroke protocols that can further be utilized by other communities with similar barriers to access to care.