Regional inequities in acute stroke care in Norway: a national benchmark for the “stroke action plan for Europe” implementation

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INTRODUCTION: The Stroke Action Plan for Europe (SAP-E) calls for equitable access to evidence-based acute stroke care, yet within-country variation remains underexplored. We mapped reperfusion capabilities, imaging resources and organisational structures across all Norwegian hospitals providing acute stroke care. PATIENTS AND METHODS: In 2024, we conducted a cross-sectional survey of all 50 acute stroke hospitals. Data covered reperfusion protocols, advanced imaging availability and the organisational maturity of regional stroke networks. Hospitals were categorised by their most advanced routinely available strategy: intravenous thrombolysis (IVT) within 0-4.5 h (IVT ≤ 4.5 h); IVT in wake-up stroke; IVT in both wake-up stroke and the extended window or endovascular thrombectomy (EVT) capability. RESULTS: All hospitals providing local acute stroke treatment offered IVT ≤ 4.5 h, while 3 hospitals in South-Eastern Norway had a stroke unit but transferred all acute patients directly to a comprehensive stroke centre. Eleven hospitals (22%) provided IVT ≤ 4.5 h only, 8 (16%) implemented IVT for wake-up stroke and 28 (56%) offered IVT for both wake-up and extended-window thrombolysis. Eight hospitals (16%) were EVT-capable, unevenly distributed. CT perfusion (CTP) was available in 28 hospitals (56%), and acute MRI in 17 (34%). Regional stroke networks varied widely in structure and activity, from well-organised, funded systems to inactive or absent networks. CONCLUSION: Norway shows universal IVT access within 0-4.5 h but marked regional variation in advanced treatment, imaging and coordination. Strengthening and standardising regional stroke networks may be key to achieving SAP-E's vision of equitable, high-quality care.

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