TY - JOUR
T1 - MENA-adapted guidelines for acute ischemic stroke management
T2 - a regional approach to global evidence
AU - Mansour, Ossama Yassin
AU - Ezzeldin, Mohamad
AU - Nour, May
AU - Hassan, Ameer
AU - Zaidi, Syed F.
AU - Jumaa, Mouhammad A.
AU - Aladham, Farid
AU - Alnaami, Ibrahim
AU - Al-Jehani, Hosam Maher
AU - Alshamy, Abdulrahman
AU - Alghamdi, Faisal
AU - Ozdemir, Atilla Ozcan
AU - Hassan, Tamer
AU - Eldeen, Hany Zaki
AU - Hamadani, Hany
AU - Hussain, M. Shazam
AU - Sharifipour, Ehsan
AU - Gurkas, Erdem
AU - Alaa Habib, Mohamed
AU - Hammami, Nadia
AU - Salah, Hosam
AU - Hassan, Farouk
AU - Hussain, Syed I.
AU - Imam, Yahia
AU - John, Seby
AU - Qureshi, Adnan
AU - El Khamlichi, Amina
AU - Mahmoud, Amr
AU - Ossama, Ahmed
AU - Mahmoud, Mostafa
AU - Mohamed, Ehab S.
AU - Nasr, Nada
AU - Rashid, Umair
AU - Said, Salma
AU - Saied, Abdulmonem
AU - Saqqur, Maher
AU - Sobh, Khalid
AU - Wasay, Mohammed
AU - Ghorbani, Mohammed
AU - Pandian, Jeyaraj
AU - Siddiqui, Adnan
AU - Shuaib, Ashfaq
N1 - Publisher Copyright:
© 2026 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2026
Y1 - 2026
N2 - 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.
AB - 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.
KW - Acute ischemic stroke
KW - conflict medicine
KW - cultural adaptation
KW - mechanical thrombectomy
KW - MENA region
KW - resource-limited settings
KW - secondary prevention
KW - thrombolysis
UR - https://www.scopus.com/pages/publications/105033019508
U2 - 10.1080/01616412.2026.2637833
DO - 10.1080/01616412.2026.2637833
M3 - Article
AN - SCOPUS:105033019508
SN - 0161-6412
JO - Neurological Research
JF - Neurological Research
ER -