BACKGROUND:Acute stroke is frequently complicated by new-onset cardiac or thromboembolic events, referred to as Stroke-Heart Syndrome (SHS). The role of stroke subtype and lesion location in determining SHS risk remains underexplored. METHODS:We conducted a retrospective analysis of data from the hospital-based Perugia Stroke Registry (March 2005-September 2019). Patients with acute neurological symptoms were classified as ischaemic stroke (IS) or haemorrhagic stroke (HS) based on neuroimaging. Logistic regression identified predictors of stroke subtype and in-hospital complications. Subgroup analyses compared first-ever versus recurrent strokes, and lesion location (lacunar, non-lacunar anterior, or non-lacunar posterior for IS; typical versus atypical for HS). The primary outcome was a composite of all-cause death, cardiac events and venous thromboembolic events during Stroke Unit stay. Secondary outcomes were each component. RESULTS:Among 2080 patients (mean age 72.8 ± 12.5 years; 57% male), 1788 (86%) had IS and 292 (14%) HS. During Stroke Unit stay (median 8 days, IQR 5-14), HS patients had higher rates of the composite outcome (26% vs 14%) and all-cause death (21.2% vs 8.8%) than IS. In IS, non-lacunar posterior and anterior strokes were associated with increased risk of composite outcome (OR 1.97, 95%CI 1.10-3.63; OR 1.61, 95%CI 0.96-2.81) and all-cause death (OR 3.35, 95%CI 1.35-9.51; OR 2.90, 95%CI 1.28-7.79) versus lacunar strokes. Among HS, atypical lesions increased risk of composite outcome (OR 2.51, 95%CI 1.24-5.22) and all-cause death (OR 2.80, 95%CI 1.31-6.17). CONCLUSIONS:Lesion location is a key determinant of SHS. Non-lacunar posterior stroke and atypical HS predict higher mortality and cardiovascular complications.

Introduction and Aim of the Work: Numerous studies have shown contradictory data regarding sex differences in pre- and in-hospital delays of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Our objective was to investigate these differences among Egyptian patients presenting with AIS. METHODS:This prospective, single-center, open-label cohort study was conducted from September 2022 to December 2023. Patients with IVT-eligible AIS, who did not receive IVT, were included in the study. Patients were recruited from the largest tertiary stroke center in the south of Egypt. All participants underwent a full neurological assessment including NIHSS, laboratory workup, and computed tomography or magnetic resonance imaging. The patients were subjected to a structured questionnaire designed to determine the parameters and time metrics associated with prehospital and in-hospital delays. RESULTS:A total of 897 patients, 41.8% of whom were females, were included in our study. General demographic characteristics were similar between both groups. A total of 70.9% of female patients and 65.1% of male patients arrived at stroke-ready hospital outside the therapeutic time window. Female patients experienced a significantly longer duration from symptom onset to hospital arrival (600 ± 618 min) compared to male patients (480 ± 438 min). Stroke misdiagnosis was nonsignificantly higher among the female group (58.9%). The time spent in the hospital did not significantly differ between males and females. CONCLUSION:The study results indicate a significant disparity in the management of female stroke patients in both prehospital and in-hospital settings, with the most pronounced delays occurring during prehospital care.

Introduction Despite advances in clinical care and treatment options, recurrent stroke risk remains significant. The unmet needs and challenges in secondary stroke prevention (SSP) after a non-cardioembolic ischaemic stroke are not fully understood, leaving many patients at risk of stroke recurrence. This study summarises expert consensus on the challenges in current SSP treatment and management. Patients and methods We conducted a 2-round modified Delphi study with 13 international stroke experts. This multidisciplinary panel included stroke neurologists, a stroke nurse, a dementia care nurse with lived experience and patient advocacy group representatives. The Delphi co-chairs developed 11 statements which were presented to the experts. Agreement was sought through a 2-round, anonymous survey and a final consensus discussion. Results All 11 statements achieved consensus after the 2 survey rounds. The statements addressed key areas including the burden of recurrent stroke, treatment and lifestyle interventions, management of stroke care and future needs to enhance SSP. Conclusion This is the first Delphi-based global consensus focused specifically on unmet needs in SSP. The experts agreed on several challenges-notably, recurrent stroke risks-and consistently emphasised that the impact of recurrent stroke is underappreciated. This Delphi panel's strong consensus underscores the real-world barriers, clinical inefficiencies and unmet needs that remain in SSP treatment and management. Addressing these challenges will require sustained investment in SSP treatments, education and innovation.

Abstract Background and aims Risk and impact of stroke recurrence is high. Advancements in secondary stroke prevention (SSP) have not substantially reduced since the millennium. Consensus (75% agreement) was gained by a multi-stakeholder expert panel on challenges in SSP. We present their call for multistakeholder action to enable meaningful reduction in recurrence risk and improved patient outcomes. Methods We conducted a modified Delphi study with 13 international stroke experts, including stroke survivors and patient advocates. After two anonymous survey rounds and one discussion, consensus was achieved on 11 statements relating to challenges in SSP treatment and management. Results Our study achieved consensus that sustained investment in management, support and new treatment options for SSP is needed to improve quality of life for survivors and caregivers, and to achieve long-term cost savings. Optimal prevention of recurrence requires healthcare professionals, stroke survivors and their caregivers to be ‘partners in prevention’. Consensus on this was achieved by 100% of panel members following the discussion round. Our analysis also identified measures for implementation and advocacy to improve outcomes for stroke survivors. Conclusions We demonstrate multidisciplinary consensus on the need for sustained attention to SSP management, support and innovation. This will enable new developments in SSP to achieve their potential to improve outcomes, while optimising use of post-stroke resources. Realisation of these changes will require aligned action across key stakeholders, including those involved in stroke care and beyond – with stroke and cardiovascular health plans including SSP, supported by clear guidelines and policies. Conflict of interest All authors received honoraria from Bayer AG in recognition of their participation in the Delphi process. VC reports receiving payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from Daiichi Sankyo, Pfizer BMS, Bayer and Ever Pharma; consulting fees from Daiichi Sankyo, Pfizer BMS and Bayer; support for attending meetings and/or travel for Daiichi Sankyo, Bayer and Ever Pharma; participation on a data safety monitoring board or advisory board for Bayer. TH reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from Bayer and Daiichi Sankyo. LL reports she is the Deputy vice president of Chinese stroke association (unpaid role). GMD reports consulting fees from Bayer as well as being part of a steering committee. CC reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from Biogen, BMS, Bayer, Amgen; participation on a data safety monitoring board or advisory board from Novartis and Boehringer-Ingelheim. The other authors report no competing interests.

The heterogeneous pathophysiology of ischaemic stroke (IS) complicates risk stratification and therapeutic decision-making. Among aetiological subtypes, embolic strokes of undetermined source (ESUS) remain particularly challenging in terms of aetiology, management, and prognosis. The aim of this study was to identify distinct clinical phenotypes of IS with a specific emphasis on delineating the clinical landscape of ESUS. We analysed 1,533 patients with acute IS enrolled in the Perugia Stroke Registry (2005–2019). Latent class analysis (LCA) was used to identify clinical phenotypes based on demographics, vascular risk factors, stroke severity, and aetiology. A secondary LCA was performed among ESUS patients to explore sub-phenotypic heterogeneity. The primary composite outcome included all-cause death, cardiac events, and venous thromboembolism during hospital stay. Secondary outcomes included individual components of the primary outcome, haemorrhagic transformation (HT), and poor functional recovery (defined as mRS worsening from 0–2 to 3–6). Three phenotypes emerged using LCA, as follows: (i) non-cardioembolic (n = 761), predominantly male, high cardiovascular burden, moderate severity; (ii) cardioembolic (n = 557), older, mostly female, high prevalence of atrial fibrillation, more severe strokes; and (iii) ESUS (n = 215), younger, fewer comorbidities, heterogeneous severity. The cardioembolic class showed increased risk of the composite outcome (OR 2.18; 95

BACKGROUND:We aimed to conduct an individual patient data meta-analysis on blood neurofilament light chain (NfL) in ischemic stroke (IS) to enhance its clinical applicability. METHODS:We performed a systematic literature search of studies on blood NfL measured in adult patients within 30 days after IS onset and derived age- and BMI-adjusted Z-scores based on a previously published reference population of healthy controls. We collected clinical, radiological and biochemical parameters of IS patients and tested associations of NfL at defined timepoints after IS onset (D1: < 24 h; D2: 24-48 h; D3: 48-72 h; D4-5: 72-120 h; D6-7: 120-168 h; D8-30: > 168 h) with baseline characteristics and 3-month follow-up outcomes (modified Rankin Scale, mRS; survival). RESULTS:We included 4081 blood NfL values from 2872 participants (IS n = 1985, transient ischemic attack n = 88, healthy controls n = 799) of 18 published studies and 3 unpublished cohorts. In patients with IS, NfL Z-score progressively increased from D1 [median: 2.0 (IQR: 0.9-2.9)] to D6-7 [median: 3.5 (IQR: 3.0-3.8)], with discriminative ability being high for IS vs. controls (AUC: 0.79-0.97) and fair for IS vs. TIA (AUC: 0.64-0.80). Higher NfL Z-score at D1 was associated with greater risk of symptomatic intracranial hemorrhage (aOR = 1.33, p = 0.014) and, from D2 onwards, with larger infarct lesion volume (highest Spearman's rho: 0.795 at D6-7). NfL independently predicted a mRS > 2 (aOR = 1.31, p < 0.001) and mortality (aOR = 1.67, p < 0.001) at 3 months. CONCLUSIONS:Blood NfL level was progressively elevated after IS, could discriminate IS from healthy controls with high accuracy and had prognostic value for intra-hospital complications and 3-month clinical outcomes in IS.

Abstract Background and aims Timely access to acute stroke reperfusion therapies depends on geographic proximity to capable hospitals and remains heterogeneous across regions. We applied MAPSTROKE to quantify Italy’s regional/national access to reperfusion-capable hospitals and to identify targeted facility upgrades to reach a ≥90% access benchmark. Methods Using MAPSTROKE geospatial modelling, 2023 stroke incidence and population were mapped on a fine hexagonal grid. Hospitals were classified as Comprehensive Stroke Centres (CSC), Primary Stroke Centres (PSC), Acute Stroke-Ready Hospitals (ASRH), or Potential Acute Stroke Centres (PASC). Road-network isochrones were generated to estimate the proportion of incident acute ischemic strokes (AIS) within 45 minutes of any reperfusion-capable hospital (ASRH/PSC/CSC). Regions with <90% coverage were optimised via a Partial Set Covering model to minimise PASC-to-ASRH conversions; sensitivity analyses used 30- and 60-minute thresholds. Results Among 535 hospitals (80 CSCs, 132 PSCs, 22 ASRHs, 301 PASCs), 91.7% of incident AIS were within 45 minutes of a reperfusion-capable hospital. Regional coverage ranged from 33.9% (Basilicata) to 98.4% (Liguria). National 45-minute CSC (EVT-capable) coverage was 75.7%, ranging from 93.2% (Lombardia) to 0% (Basilicata, Molise). Coverage at 30 and 60 minutes was 79.6% and 96%, respectively. After converting 23 PASCs to ASRHs in seven under-covered regions, all regions except Basilicata achieved ≥90% coverage. Conclusions Italy has high overall geographic access to reperfusion-capable hospitals, but substantial regional inequities persist, particularly for CSC/EVT access; MAPSTROKE supports targeted upgrades to reduce gaps. Funded by the WSO Pilot Research Proposal Grant and the Angels Initiative/Boehringer Ingelheim (contract nos. 782566 and 1005232). Conflict of interest E.N. is member of the medical and scientific advisory board of Cercare Medical. L.A.C. acknowledges receiving a grant from the World Stroke Organization and the Angels Initiative/Boehringer Ingelheim (contract nos. 782566 and 1005232) for this work. A.C., E.F., A.S.F., L.L.D., M.B., M.D., P.S., V.C., and D.T. have nothing to disclose. Figure 1 - belongs to Results

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.

Introduction: intracerebral hemorrhage (ICH) remains one of the most fatal forms of stroke, associated with high mortality and significant long-term disability. Structured diagnostic and therapeutic care pathways (PDTA) may improve early management and clinical outcomes. This study aimed to evaluate the impact of a standardized PDTA for spontaneous ICH in a tertiary stroke center. Methods: We conducted a single-center, observational before–after cohort study including 578 consecutive patients with spontaneous ICH admitted between 2019 and 2025. Patients were divided into pre-PDTA (n=382) and post-PDTA (n=195) groups. Primary outcomes were 30-day mortality and process-of-care indicators, including early neurosurgical consultation and initiation of antihypertensive and anti-edema therapies in the emergency department. Results: Baseline characteristics were comparable between groups, including age (71.8±15.2 vs 73.8±13.9 years) and admission severity (GCS 10.7±4.7 vs 10.8±4.6). Following PDTA implementation, significant improvements were observed in process-of-care measures. The proportion of patients receiving neurosurgical consultation within 60 minutes increased from 30.9% to 57.4% (p=0.02), while the use of antihypertensive therapy rose from 16.5% to 36.4% (p=0.003) and anti-edema therapy from 9.7% to 19.0% (p=0.002). At the same time, the overall rate of neurosurgical intervention decreased from 35.6% to 25.6% (p=0.02). Despite these improvements, 30-day mortality did not significantly differ between groups (30.5% vs 35.6%, p=0.20), and this finding was confirmed after adjustment (HR 1.30, 95% CI 0.85–2.00, p=0.23). However, among patients undergoing neurosurgical treatment, mortality decreased from 25.7% in the pre-PDTA period to 16.0% in the post-PDTA period (HR 0.628, 95% CI 0.397–0.995, p=0.047). Multivariable analysis identified admission GCS (HR 0.897, p<0.001), midline shift greater than 1 mm (HR 1.66, p=0.045), and hematoma volume (HR 1.017 per mL increase) as independent predictors of 30-day mortality. Conclusions: implementation of a structured PDTA improved key process-of-care measures and was associated with better outcomes among surgically treated patients, although no overall reduction in 30-day mortality was observed. Outcomes in ICH appear to depend not only on hemorrhage characteristics but also on the organization and coordination of care, supporting the role of structured, system-based approaches in this time-sensitive condition.

Introduction: The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducted a sub-analysis of the RAF and RAF-NOAC studies to evaluate the efficacy and safety of statins in secondary prevention in patients with acute ischemic stroke and AF. Materials and methods: We combined patient data from the RAF and RAF-NOAC studies, prospective observational studies conducted across Stroke Units in Europe, the United States, and Asia from January 2012 to June 2016. We included consecutive patients with AF who suffered an acute ischemic stroke with a follow-up of 90 days. Our outcomes were the combined endpoint, including stroke, transient ischemic attack, systemic embolism, symptomatic intracerebral hemorrhage, and major extracranial bleeding. Furthermore, both ischemic and hemorrhagic outcomes were evaluated separately. Results: A total of 1742 patients were included (46% male), and 898 (52%) received statins after the index event, of whom 436 (48.6%) were already taking statins before the index event, 462 (51.4%) started treatment after. At multivariable analysis, statin use was statistically associated with age (OR 0.92, 95% CI 0.97–0.99, p = 0.001), male sex (OR 1.35, 95% CI 1.07–1.70, p = 0.013), anticoagulation (OR 2.53, 95% CI 1.90–3.36, p < 0.0001), hyperlipidemia (OR 5.52, 95% CI 4.28–7.12, p < 0.0001), paroxysmal AF (OR 1.40, 95% CI 1.12–1.75, p = 0.003), leukoaraiosis (OR 1.39, 95% CI 1.11–1.75, p = 0.004) and heart failure (OR 0.72, 95% CI 0.53–0.98, p = 0.034). Statin use was not associated with the combined outcome event (OR 0.84, 95% CI 0.58–1.23, p = 0.3) and ischemic outcome event (OR 1.17, 95% CI 0.73–1.88, p = 0.5) while was associated with a lower risk of hemorrhagic outcome event (OR 0.51, 95% CI 0.28–0.91, p = 0.02). Discussion: Statins protect cerebral arterial vessels (particularly small vessels) from subacute damage due to hypertension, diabetes, and other harmful agents (such as reactive oxygen species, proinflammatory cytokines, etc.) due to their systemic anti-inflammatory and endothelium-protective effects. Conclusions: Our data show that statins seem to protect against global bleeding events in cardioembolic stroke patients; this may be due to the pleiotropic effect of statins. More data are warranted to confirm these findings.

A care bundle approach to the management of spontaneous intracerebral hemorrhage (ICH) has been shown to benefit patients in low- and middle-income countries (LMIC), but uncertainty persists over the specific components and its applicability in high-income countries (HICs). An international collaborative initiative aimed at determining whether implementation of a care bundle improves functional outcome for patients with ICH in HIC. An international, multicenter, batched, parallel, cluster-randomized clinical trial focused on implementation and quality improvement for adults with spontaneous ICH ⩽ 24 h of symptom onset. The care bundle includes time- and target-based interventions: early intensive blood pressure lowering, hyperglycemia and pyrexia management, anticoagulation reversal, avoidance of do-not-resuscitate orders, repeat imaging, and referral pathways for intensive care and neurosurgery. An embedded process evaluation will assess the effectiveness and implementation of the care bundle. A total of 110 hospitals with 3500 ICH participants is estimated to provide 90% power (α = 0.05) to detect a plausible treatment effect of 0.20 improvement in utility-weighted modified Rankin scale (UW-mRS) scores. The primary outcome is UW-mRS at 6 months. Secondary outcomes include death, functional status, and health-related quality of life. Implementation outcomes include adoption, fidelity, acceptability, sustainability, and integration. We aim to provide reliable evidence to accelerate practice change for integration of a multifaceted ICH care bundle as a critical component of acute stroke care worldwide. Clinicaltrials.gov Identifier: NCT06429332.

In patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke. To investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure. In this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic–Atrial Fibrillation (OCEANIC-AF) randomized clinical trial, patients enrolled in the OCEANIC-AF trial were categorized as OAC naive or OAC experienced based on whether they had 6 or fewer weeks or more than 6 weeks of prior OAC use. The effect of asundexian vs apixaban was then compared on outcomes among patients who were OAC naive and OAC experienced. The study setting included 1035 sites in 38 countries, and participants were those enrolled in the OCEANIC-AF trial. Data were analyzed from June to July 2024. Asundexian, a novel factor XIa inhibitor, was compared with apixaban in patients with AF. The primary efficacy outcome was stroke or systemic embolism. The main safety outcome was major bleeding. Of patients in the OCEANIC-AF trial, 2493 (17%) were OAC naive (mean [SD] age, 72.6 [8.6] years; 1464 male [59%]) and 12 317 (83%) were OAC experienced (mean [SD] age, 74.2 [7.5] years; 8132 male [66%]). In the asundexian arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.8% (10 of 1238) compared with 1.4% (88 of 6177) in those who were OAC experienced. In the apixaban arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.6% (7 of 1255) compared with 0.3% (19 of 6140) in those who were OAC experienced. Thus, patients who were OAC naive had a smaller increase in stroke or systemic embolism with asundexian compared with apixaban (hazard ratio [HR], 1.42; 95% CI, 0.54-3.73) than patients who were OAC experienced (HR, 4.66; 95% CI, 2.84-7.65; P for interaction =.03). Bleeding rates were lower among both OAC-naive patients (0.2% [2 of 1228]) and OAC-experienced patients (0.2% [15 of 6145]) assigned asundexian than among OAC-naive patients (1.0% [13 of 1249]) and OAC-experienced patients (0.7% [40 of 6115]) assigned apixaban. In the OCEANIC-AF randomized clinical trial, patients with AF who were OAC naive had a smaller increase in stroke or systemic embolism and a similar lower rate of bleeding with asundexian compared with apixaban than patients who were OAC experienced. The mechanism of these findings is unknown and deserves further research. ClinicalTrials.gov Identifier: NCT05643573

BACKGROUND:Leadership development is essential to advancing stroke care globally. The World Stroke Organization (WSO) Future Stroke Leaders Program (FSLP) was established to identify and support global early-career professionals in stroke care worldwide. The program offers structured leadership training, mentorship, and seed funding for implementation projects. Selection criteria prioritize diversity, leadership potential, and institutional support. The article describes the design and implementation of the WSO FSLP and evaluates its contribution to stroke care advancement, professional development, and global collaboration. METHODS:This is a descriptive narrative of the WSO FSLP, based on program documentation, participant surveys, and public databases. Programmatic key performance indicators (KPIs) aligned with WSO's strategic goals were used to track impact. RESULTS:Among 56 participants in the first two cohorts, selected from over 35 countries, engagement with the WSO FSLP contributed to improved access to and delivery of care by developing stroke services in underserved areas, enhancing publication output, and supporting active involvement in international policy and advocacy efforts. Participants reported career advancement, increased research engagement, and expanded collaborative networks as a direct result of their participation in the program. CONCLUSIONS:The WSO FSLP is a model for developing global stroke leadership. Its impact spans clinical innovation, academic research, and policy influence, guiding implementation. Continued program adaptation to the changing international landscape, alumni engagement, and long-term impact evaluation will help sustain and scale worldwide contributions to stroke care equity.

Background: Stroke is a leading cause of long-term disability worldwide. Timely and adequate rehabilitation is crucial for post-stroke recovery, but access is limited due to an overburdened healthcare system, medical personnel shortages, and insurance barriers. Rehabilitation access is especially limited for stroke survivors in rural and low-income regions. Innovative solutions like telerehabilitation are needed to expand access. This study examines current rehabilitation practices, costs, and global telerehabilitation models, as well as barriers to rehabilitation utilization. Methods: We conducted an online survey aimed at stroke care providers, affiliated societies, and partner organizations to collect comprehensive data on the availability and practices of post-stroke rehabilitation and telerehabilitation across various regions. Results: A total of 523 responses were collected from 62 different countries (Fig1), with the majority of respondents being physicians (66.7%), followed by physiotherapists (15.7%). Most respondents reported working in urban areas (82.9%) and were primarily employed in public community hospitals (40.5%), with a significant portion also working in academic institutions (35.3%). Regarding experience, 45.1% of respondents had over 10 years of experience in the stroke field. Telerehabilitation services for stroke were not offered by most of the surveyed sites (71.1%). Among those that did provide telerehabilitation, most sessions were individualized for a single patient (34.7%), followed by sessions involving two patients (24.8%). Notably, 18.36% of the sites offered sessions for groups of more than 10 patients at a time. The frequency of sessions varied, with the majority offering a single session per week (30.6%), followed by two sessions per week (20%), while only 8% provided sessions five days a week. On average, the duration of these sessions ranged from 31 to 60 minutes (53.1%). The most reported barriers to providing adequate telerehabilitation services included the availability of electronic hardware devices (12.9%) and internet access (12.9%). Other significant barriers included poor video call quality (10.4%) and the lack of clear guidelines and protocols (9.2%). Conclusion: The survey results provide a comprehensive overview of current practices and availability of post-stroke rehabilitation and telerehabilitation, highlighting the global burden of post-stroke disability due to limited access to rehabilitation.

This World Stroke Organization Scientific Statement highlights how sex and gender differences shape stroke risk, treatment, care, and research. Estrogen confers a relative protection before menopause, with risk increasing thereafter. Beyond shared cardiovascular determinants (hypertension, atrial fibrillation, and diabetes), women face sex-specific risks-hypertensive disorders of pregnancy, menopause, and hormone therapy, with clear implications for stroke prevention and management. Despite comparable efficacy of acute and secondary stroke therapies in women and men, women are less likely to receive timely acute treatment and often experience delays in recognition and access. The statement recommends gender-responsive prevention and care pathways; systematic consideration of pregnancy-related and menopausal factors; and public and professional education to improve stroke symptom recognition and purposeful inclusion of women across the research continuum. By integrating evidence from epidemiology, acute care, and secondary prevention, this statement provides clear and timely guidance for reducing inequities and shaping future research and policy to achieve equitable stroke care globally.