Get there early. Whatever the cause of the cerebral stroke, more often ischemia, less frequently hemorrhage, urgency in treatment is fundamental. Because every minute you lose you literally “burn” neurons. But when evaluating the path of the stroke we must start first, from prevention, and then move on to the timeliness of treatments and rehabilitation strategies.
This is remembered by experts, who also focus attention on the acute phase of the stroke, as indicated by the Action Plan for Stroke in Italy 2024–2030 (SAP-1). It is essential to contribute to improving a situation in which cerebral stroke is one of the most relevant health emergencies at a European level. This was worked on at ISA-AII 2026, the national Congress which brought together clinicians, researchers, health policy decision-makers and representatives of patient associations around a shared objective: to guarantee every person affected by a stroke, regardless of the geographical area of residence, timely, appropriate and continuous access to the best available care.
The situation in Europe
In 2025, around 1.46 million cases were recorded in the 47 countries of the old continent with an economic impact estimated at 60 billion euros and a persistent lack of homogeneity in access to care: Stroke Units (i.e. dedicated units), systemic thrombolysis, mechanical thrombectomy and structured follow-up remain unevenly distributed between the different national healthcare systems. In this sense, the Stroke Action Plan for Europe 2018–2030 (SAP-E), updated halfway in 2026, proposes four interconnected strategic objectives:
- reduce the incidence of stroke, standardized by age and sex, by more than 15% by 2030;
- ensure that at least 90% of patients in the acute phase are admitted to a Stroke Unit as the first level of care;
- equip each country with a national plan structured along the entire continuum, from primary prevention to rehabilitation and life after stroke;
- intervene in a multisectoral way on risk factors and on the environmental, social and educational determinants of cerebrovascular health.
What is proposed for Italy
The Italian healthcare system shows significant results in the management of the acute phase of stroke, in particular in the administration of systemic thrombolysis, but still presents significant areas for improvement in terms of secondary prevention, national governance and systematic reporting of clinical outcomes.
The Action Plan for Stroke in Italy 2024–2030 (SAP-I) responds to this need by configuring itself as a strategic platform to connect clinical networks, data flows, audit processes and institutional responsibilities. The objective is to translate good practices developed at regional level into comparable and verifiable national standards, bridging the gap between local excellence and the healthcare system as a whole.
“Stroke today requires a vision that goes beyond the single clinical performance. Building the future of care means making good practices structural, overcoming territorial inequalities and strengthening national governance based on networks, data and shared responsibilities. ISA-AII 2026 reaffirms the need to transform excellence into a concrete and measurable right for all people affected by stroke”
reports Mauro Silvestrini, Past President ISA-AII.
SAP-I priorities and AI help
ISA-AII 2026 marks a paradigm shift: the transition from the sum of local excellences to a measurable, sustainable and person-centred national strategy. Operational priorities identified by SAP-I include:
- alignment of Italian care standards with the European SAP-E benchmarks;
- definition of a minimum national dataset with continuous audit systems;
- systematic measurement of access to the stroke unit within 24 hours of symptom onset;
- standardization of Diagnostic-Therapeutic and Assistance Pathways (PDTA) on a national scale.
As Leonardo Pantoni, ISA-AII President-elect, reminds us, the priorities indicated by SAP-I are concrete:
“Align Italian care standards with European benchmarks, define a minimum national dataset with continuous audit, measure access to the stroke unit within 24 hours, standardize PDTAs, make the rehabilitation plan and care transition mandatory”.
In this context, artificial intelligence, telemedicine and digital medicine do not represent mere technological applications, but a real equity infrastructure for the stroke care system. The evidence deriving from the implementation of SAP-E in different European contexts shows that solutions based on artificial intelligence can improve pre-hospital assessment and integration between territorial teams and hospital structures; that telemedicine is applicable and clinically useful in areas with a low density of specialist centers, where it facilitates triage, supports urgent therapeutic decisions and allows flexible organizational models along all phases of the stroke network.
In Italy, 7 Telestroke networks are currently operational and have demonstrated a significant impact on the accessibility and equity of care. Digital medicine solutions also extend from the management of the acute phase to home monitoring for the prevention of relapses, to motor and cognitive rehabilitation, up to long-term quality of life support.
How to follow the patient
Integrated management and therapeutic continuity represent the most critical issue – and at the same time the most ambitious challenge – of the entire stroke care system. Secondary prevention, individual rehabilitation planning, care transition, control of cardiovascular risk factors and attention to the quality of life post-stroke – including support for caregivers – constitute the pillars of a model that cannot be relegated to the acute hospital phase alone. The personalization of therapy, in this framework, is not reduced to the selection of the most appropriate drug, but translates into designing the right path for the right person, at the right time: a principle that requires robust information systems, trained professionals and governance capable of guaranteeing the coherence of the clinical-care path.
“Stroke does not end with discharge. The real innovation today is to build a system capable of being rapid in the acute phase, continuous in follow-up, solid in data and fair in access. Technology only has value if it reduces distances, increases equity and makes care more personalized”
concludes Paola Santalucia, ISA-AII President.
