ABSTRACT NUMBER: ESOC2026A762 MEASURING ACCESS TO STROKE REPERFUSION TREATMENT IN ITALY USING MAPSTROKE

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