Objective To investigate the status and homogeneity of pre-hospital warning and in-hospital green channel process management of patients with acute ischemic stroke in tertiary first-class hospitals in different administrative regions of China.Methods Convenience sampling method was conducted among experts in the field of interventional therapy of cerebrovascular diseases in China. Then, the ALICE questionnaire (Chinese version of questionnaire on the status of intravascular treatment of cerebrovascular diseases-ALICE study) was sent to them by WeChat Mini Program (the online survey tool Sojump) or e-mail. The survey contents included the basic information of the hospital, the treatment status of cerebrovascular diseases (acute ischemic stroke, intracranial aneurysm, arteriovenous malformation and non-stenotic carotid plaque) and patient transfer system. The status of green channel process management in 7 administrative regions (North, Northeast, East, Central, South, Southwest and Northwest) of China and the saved time of door-to-treatment after optimizing the management strategies were analyzed.Results A total of 142 questionnaires were distributed, 11 incomplete questionnaires were excluded, and 131 valid questionnaires were collected. The 131 neurointerventional physicians were from 126 tertiary first-class hospitals. Hospitals with more than 100 cases of mechanical thrombectomy every year accounted for 31.0% (39/126). Direct admission by ambulance was the main mode of care for emergency acute ischemic stroke patients (53%[35%, 70%]). There were slight differences in the pre-hospital warning mechanism, emergency pre-examination, space layout between CT machine and catheter operation room, general anesthesia protocol and preparation for mechanical thrombectomy among the hospitals in different administrative regions, showing no significant differences (all P > 0.05). Anesthesiologists in a callable state throughout the day, optimization of the imaging procedure, position optimization or functional integration of CT machine and advance warning mechanism could shorten the time of door-to-treatment by 21 (19, 30), 20 (15, 30), 20 (12, 25) and 19 (10, 23) min, respectively.Conclusion There is a high homogeneity of in-hospital green channel treatment process for acute ischemic stroke among the tertiary first-class hospitals in different administrative regions of China. Avoiding unnecessary steps, planning a reasonable stroke green channel and parallel-management can greatly improve the rescue and treatment efficiency.