Study highlights major advances in stroke care infrastructure while revealing regional inequalities and challenges to ensuring quality across the country. 

Published in the scientific journal Cerebrovascular Diseases and conducted with the participation of the D’Or Institute for Research and Education (IDOR), a recent study analyzed the evolution of stroke care in Brazil between 2008 and 2022. The research reveals significant growth in the country’s stroke care network, driven by public policies, while also identifying structural bottlenecks and regional inequalities that continue to affect patient care. 

Why organizing stroke care saves lives 

Stroke remains one of the leading causes of death and disability in Brazil. In acute cases, every minute counts. Strategies such as admission to specialized stroke units and rapid access to reperfusion therapies, which restore blood flow to the brain, are internationally recognized as cost-effective and essential for reducing mortality and long-term disability. In these emergencies, ensuring that each patient receives the appropriate treatment at the right time is often even more important than simply having advanced technology available. 

Comparing the infrastructure available in 2008 with the situation established by 2022, the authors observed remarkable progress. The number of specialized stroke centers in Brazil increased from 35 to 246 following the implementation of national policies, including the National Stroke Care Policy launched by the Ministry of Health in 2012. This growth reflects investments in funding, workforce training, and the establishment of minimum standards for these services. 

How the study evaluated stroke centers 

The research used a nationwide online survey based on the World Stroke Organization (WSO) Roadmap, a framework that provides standardized, evidence-based protocols and recommendations for stroke care. Centers were classified as essential if they offered intravenous thrombolysis and as advanced if they also provided mechanical thrombectomy. The study also assessed hospital infrastructure, the availability of multidisciplinary teams, and adherence to treatment protocols aligned with national and international guidelines. 

Progress alongside persistent inequalities 

Despite the progress, the findings reveal an uneven landscape. Of the 216 centers evaluated, 77% were located in the South and Southeast regions of the country. Most advanced centers belonged to the private healthcare sector, while essential centers were predominantly public. 

Although basic diagnostic testing and thrombolysis were widely available, fewer than half of the hospitals had dedicated stroke units, and only 47% provided mechanical thrombectomy services around the clock. 

The lack of standardized care pathways also affects patient outcomes. Researchers suggest that telemedicine could serve as a strategic tool to bring specialized expertise to underserved regions, supporting clinical decision-making in real time. In addition, certification programs inspired by the WSO model may help standardize practices, reduce variations in care, and improve outcomes nationwide. 

An important step forward and the road ahead 

The study concludes that, while expanding the number of centers was a highly positive achievement, it was not sufficient on its own. Brazil has made consistent progress in structuring stroke care but still faces significant challenges related to equity, particularly within the public healthcare system. 

According to the authors, consolidating the recommendations of the WSO Roadmap, expanding stroke center certification, and strategically implementing telemedicine will be crucial to transforming growth into quality and ultimately saving more lives throughout the country. 

Written by Maria Eduarda Ledo de Abreu