The Treatment Gap in Acute Ischemic Stroke Worldwide: A Call to Improve Care

Cerebral infarction at left hemisphere ( Ischemic stroke ) ( CT-scan of brain ) : Medicine and Science background
Researchers sought to examine the global burden of stroke and dramatic geographic disparities in stroke incidence and access to acute ischemic stroke interventions.

Acute stroke care is cost-effective across the board in low- , middle-, or high-income countries; therefore, the call of the hour is to encourage a collaborative effort to bridge the gap in rapid therapeutic advances and its access to patients who are eligible to receive them worldwide. These are the findings of a recent study published in Neurology.

Total direct medical costs related to stroke, the second highest cause of disability and death worldwide, are projected to be $94.3 billion by 2035. In the past 5 years, eligibility for IV thrombolysis (IVT) has extended beyond 4.5 hours, based on permissible imaging criteria. The population of patients who can receive acute stroke interventions has subsequently increased, but there is still limited access to acute stroke care, mechanical thrombectomy (MT), and IVT.

The objective of the current study was to examine the global burden of stroke and the dramatic geographic disparities in stroke incidence and access to AIS interventions.

From 2010 to 2017, stroke incidence and mortality each rose 5.3%, prevalence rose 19.3%, and disability-adjusted life-years (DALYs) lost by 2.7 worldwide. Mortality rates for ischemic strokes (IS) and hemorrhagic stroke (HS) decreased from 1990 to 2010, but the number of people with incident IS increased 37% and the number of people with HS increased 47% and the deaths associated each increased by about 20%.

Globally, fewer than 5% of patients with acute IS received IVT within the therapeutic time window. Fewer than 100,000 MT were performed in 2016.

IS incidence rose from 11.6 million in 2010 to 13.7 million in 2016. There were 5.5 million deaths from stroke in 2016, while stroke prevalence was 80.1 million. In 2016, global stroke prevalence was about 1,322 per 100,000 persons, compared with about 2,320 per 100,000 persons in the US, which has 900 of the world’s roughly 2,000 MT-capable comprehensive stroke centers. Stroke case-fatality rate after 30 days was highest (42%) in Kolkata, India (2003-2010), compared with 10% in Dijon, France (2000-2004).

Incidence of stroke among patients 18 to 50 years of age (10%-15%) is higher in low- and middle-income countries.

Prehospital delays account for the largest delays for acute stroke care. Lack of advanced perfusion imaging modalities in lower income countries and rural areas in high-income countries make it challenging to evaluate patients’ eligibility for MT within the therapeutic window. There is also no central data repository for identifying how many MTs are performed in most countries.

The researchers concluded, “This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurol. Published online November 16, 2021. doi: 10.1212/WNL.0000000000012781