ISC 2026 | Improving access to reperfusion therapy and stroke care in low- and middle-income countries

So nearly 1% of acute ischemic stroke patients who were eligible for reperfusion therapy only receive reperfusion therapy within low- and middle-income countries. There is a markedly low percentage. And there are many factors lying behind that. Number one is a lack of trained personnel. And number two is cost. You know, intravenous thrombolysis, for example, is disproportionately high in low- and middle-income countries in comparison to high-income countries if we compare its price with the national income; moreover, most patients or many patients in low- and middle-income countries are out of pocket, so it’s not covered by health insurance, for example. So this is one major obstacle. Another obstacle is a lack of access to mechanical thrombectomy. Mechanical thrombectomy is still very limited in low-middle-income countries in comparison to high-income countries. So how can we increase access to reperfusion therapy? Number one, limit pre-hospital delay, increase public awareness. So I think we need to create a culturally adaptive public awareness campaign, reduce financial burden by cutting off out-of-pocket emergency fees, strengthen emergency medical services infrastructure, training, training, training for healthcare workers and doctors on how to give intravenous thrombolysis. And even in the hospital where there is no available neurologist, we can train emergency physicians to deliver intravenous thrombolysis. Regarding mechanical thrombectomy, I co-authored a manuscript with one colleague, Dr Hesham Masoud from SUNY Upstate University in New York. We proposed a model for training vascular neurologists to deliver mechanical thrombectomy only in low- and middle-income countries. So training vascular neurologists to deliver mechanical thrombectomy only will be more economic and less time-consuming rather than training them in the whole neuro-interventional pathway, which takes a lot of time. So there is another solution for implementing mechanical thrombectomy because one of the major obstacles against implementing mechanical thrombectomy in low- and middle-income countries is a lack of trained personnel. I think we need also good stroke unit care. In the countries where there is no available intravenous thrombolysis, we should build a good stroke unit and deliver good stroke unit care, like controlling blood pressure, controlling temperature, prevention of aspiration pneumonia, good mobilization of the patient to avoid bed sores, all these strategies are very important to improve outcomes and reduce mortality and morbidity of stroke patients. Improve rehabilitation services, like expand workforce capacity, upskill nurses, and train them on how to introduce rehabilitation for acute ischemic stroke patients using smart technology, tele-rehabilitation to overcome the barriers in the places where there are no available rehabilitation centers, and try to reduce financial burden as much as possible for those stroke patients.

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