Role of comprehensive stroke centers in stroke care

Since the evidence regarding the efficacy of intravenous alteplase infusion and mechanical thrombectomy in acute ischemic stroke was reported, rapid treatment for acute stroke gathered importance. The concept of primary stroke centers (PSCs) was established in 1990s in Western countries, and more than 1,000 PSCs were certified in the US. The concept of comprehensive stroke centers (CSCs) that provide advanced stroke care including neurosurgical and endovascular treatment and advanced imaging for ischemic and hemorrhagic stroke was proposed and increasing number of CSCs have been designated worldwide. In 2010, the J‒ASPECT Study was started to examine the geographical disparity of stroke care in Japan, and the effect of stroke center capabilities on outcomes of ischemic and hemorrhagic stroke using the Diagnosis Procedure Combination database. The CSC score, a structural indicator of stroke care, was shown to be associated with better outcomes in acute stroke patients, and higher availability of recombinant tissue‒type plasminogen activator infusion and mechanical thrombectomy. In Japan, certification of the PSC was started only in 2019. Further studies are necessary to improve the acute stroke care in Japan using clinical indicators.