Ischemic stroke in Peru: a scoping review of trends, outcomes, and evidence gaps

Peru faces a growing mismatch between the increasing burden of ischemic stroke and the health system's capacity to respond.

We aimed to systematically map the primary research literature on ischemic stroke in Peru using a socio-ecological framework, characterize the current evidence base, quantify key epidemiological outcomes, and identify critical knowledge gaps to inform a national research agenda.

We conducted a scoping review using the SPIDER framework and searched four databases through April 2025. We included original primary studies of Peruvian participants of any age with ischemic stroke, including observational, interventional, qualitative designs, and case reports. Study selection and data extraction were performed in duplicate. Findings were narratively synthesized across socio-ecological levels (individual, interpersonal, organizational, community, and policy/environmental). Key epidemiological outcomes were pooled using random-effects meta-analyses.

Of 1210 records, 119 studies were included (131,424 participants), with 75% conducted in Lima. Ischemic stroke represented 62% of all stroke cases; 44% were women. Overall mortality was 12%. Large-vessel atherosclerosis (27%) and cardioembolic (24%) were common etiologies, but undetermined causes remained the highest (30%). The pooled thrombolysis rate was 2.9%, with no reported access to mechanical thrombectomy in observational studies. Qualitative studies identified barriers to timely care, poor guideline adherence, caregiver burden, and centralization of services. Quality-improvement efforts showed limited impact. Community prevention and digital innovations were tested in small pilots without scale-up. Policy-level evaluation was scarce.

Research regarding stroke in Peru has increased but remains geographically centralized and structurally misaligned with the national burden. Major gaps persist in diagnostic capacity, implementation research, rehabilitation, caregiver support, and policy evaluation. A nationally coordinated and regional distributed research and system-level strengthening of the stroke program are urgently needed.

(https://doi.org/10.17605/OSF.IO/7WYX8).