The MAPSTROKE analysis of the access to stroke reperfusion treatment and stroke units in Italy

BACKGROUND: Access to reperfusion therapies and stroke unit (SU) admission remains heterogeneous across Europe. Mapping tools can reveal service gaps and guide implementation strategies. MAPSTROKE provides regional mapping of existing stroke centres and identifies potential new sites in underserved areas. AIMS: To apply a computational strategy to the Italian stroke care system to estimate national coverage for reperfusion therapies and quantify SU bed capacity under current constraints. METHODS: Using MAPSTROKE geospatial modelling, we assessed (1) 45-min access to a hospital providing reperfusion treatment and (2) SU bed coverage limited by capacity. Population and stroke incidence data for 2023 were mapped on a hexagonal grid combining sources from the Italian Ministry of Health and the Kontur Dataset. Hospitals were classified as Comprehensive (CSC), Primary (PSC), Acute Stroke-Ready (ASRH) or Potential Acute Stroke Centres (PASC). Isochrones of 45 min were generated for hospitals performing reperfusion. Regional coverage was estimated, and a Partial Set Covering identified the minimal number of PASCs required to achieve ≥ 90% coverage. Stroke unit capacity was estimated using bed counts and mean length of stay (LOS). RESULTS: Among 535 hospitals (80 CSCs, 132 PSCs, 22 ASRHs, 301 PASCs), 91.7% of strokes were within 45 min of a hospital providing reperfusion treatment. Seven regions were below 90%, 6 achieved this target after optimisation. National SU capacity covered 79.2% of annual incidence, with a gap of 255 beds (158 with ideal LOS). CONCLUSIONS: The MAPSTROKE project reveals adequate reperfusion access but critical SU capacity disparities, underscoring the need for coordinated national strategies.