Related Experiment Video
Updated: Mar 18, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
MENA-adapted guidelines for acute ischemic stroke management: a regional approach to global evidence
Ossama Yassin Mansour1, Mohamad Ezzeldin2, May Nour3
1Stroke and Neurointervention Center, Alexandria University, Alexandria, Egypt.
Insights
This study adapted international stroke care guidelines for the Middle East and North Africa (MENA) region. The new framework addresses regional challenges for acute ischemic stroke management, improving patient outcomes.
Area of Science:
- Neurology
- Public Health
- Healthcare Policy
Background:
- Stroke is a major cause of death and disability in the Middle East and North Africa (MENA).
- Low- and middle-income countries bear a disproportionate burden of stroke.
- Region-specific adaptations of acute stroke care guidelines are crucial.
Purpose of the Study:
- To develop adapted, evidence-based acute ischemic stroke management guidelines for the MENA region.
- To address regional challenges while maintaining core principles of stroke care.
- To create a resource-stratified framework for stroke management.
Main Methods:
- Systematic adaptation of international guidelines (AHA/ASA, ESO, NICE, CSA) and meta-analyses.
- Utilized MENA-SINO's seven-step framework, including expert consensus from 45 specialists across 22 MENA countries.
- Employed modified Delphi procedures with >85% agreement, adhering to AGREE II standards.
Main Results:
- Developed a regional roadmap with ten cornerstone concepts for acute ischemic stroke care.
- Key recommendations include tiered stroke systems, telemedicine, rapid reperfusion protocols (IV thrombolysis, mechanical thrombectomy), and resource-stratified care.
- Emphasized culturally sensitive decision-making, secondary prevention tailored to regional risk factors, and standardized quality metrics.
Conclusions:
- These guidelines offer the first comprehensive, resource-stratified framework for acute ischemic stroke management in the MENA region.
- Practical adaptations address diverse healthcare settings within the MENA region.
- The framework preserves essential evidence-based care components while incorporating regional needs.
Background:
Stroke remains a leading cause of mortality and long-term disability in the Middle East and North Africa (MENA) region. The substantial burden of stroke in low- and middle-income countries, where 75% of stroke-related deaths and 81% of disability-adjusted life years occur, underscores the critical need for region-specific adaptations of acute stroke care guidelines to address critical regional challenges while maintaining evidence-based core principles of care.
Methods:
We adapted evidence from multiple international guidelines (AHA/ASA 2019-2023, ESO 2021-2023, NICE 2019-2022, Chinese Stroke Association 2022) and recent meta-analyses using MENA-SINO's systematic seven-step framework including comprehensive evidence review, multidisciplinary expert panel input from 45 experts across 22 MENA countries, regional implementation barrier assessment, and formal modified Delphi consensus procedures achieving > 85% agreement. Recommendations employ modified Class of Recommendation, Level of Evidence, Resource-Limited designations, and Expert Opinion statements following AGREE II standards.
Key Recommendations:
Our regional roadmap emphasizes ten cornerstone concepts: (1) tiered stroke care systems with telemedicine networks; (2) rapid reperfusion protocols for IV thrombolysis within 4.5 hours and mechanical thrombectomy within 6-24 hours based on imaging; (3) resource-stratified care; (4) culturally sensitive decision-making frameworks; (5) aggressive secondary prevention targeting regional risk factor patterns; (6) standardized quality metrics across diverse systems; (7) comprehensive workforce development programs; (8) appropriate technology integration; (9) region-specific emergency response systems;and (10) sustainable phased implementation strategies.
Conclusion:
These guidelines provide the first comprehensive, resource-stratified framework for acute ischemic stroke management across the MENA region, with practical adaptations addressing diverse healthcare settings while preserving essential evidence-based care components.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:23Atherosclerosis IV: Nursing Management
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:22Acute Kidney Injury VI: Nursing Management
01:26Atherosclerosis III: Management