# Developing a stroke center in a Brazilian university hospital: implementation, challenges, and outcomes

## TL;DR

A stroke center at a Brazilian university hospital improved patient outcomes for acute ischemic stroke, with results comparable to international standards.

## Contribution

The study demonstrates the feasibility and effectiveness of implementing a stroke center within Brazil's public health system.

## Key findings

- Door-to-CT time was under 25 minutes for 84% of patients.
- 76% of patients achieved a modified Rankin Scale score of 0 to 2 at discharge.
- In-hospital mortality was 10.5%, with low complication rates.

## Abstract

Stroke remains the second leading cause of death worldwide and the leading cause in Brazil. The implementation of a stroke center (SC) has played a crucial role in improving outcomes, increasing both survival rates and functional recovery.

To examine the experience of Hospital Universitário de Brasília of Universidade de Brasília's (HUB-UnB) SC, focusing on its performance indicators.

The present observational, retrospective, and analytical study evaluated 19 patients diagnosed with acute ischemic stroke (AIS) who received intravenous thrombolysis with alteplase at the HUB-UnB SC between July 2021 and December 2024. Performance indicators were compared with national and international data.

The door-to-CT time was less than 25 minutes in 16 patients (84%), and the door-to-needle time was less than 60 minutes in 12 patients (63%). The mean National Institutes of Health Stroke Scale score significantly decreased from 12.4 at admission to 1.6 at discharge. Consequently, 76% of patients achieved a modified Rankin Scale score of 0 to 2. Complication rates were low, including 5.3% hemorrhagic transformation and 10.5% in-hospital mortality. No statistically significant differences were observed when comparing performance indicators with national and international benchmarks.

The implementation of the HUB-UnB's SC proved feasible and effective in providing specialized care for AIS within a university hospital of the Unified Health System (Sistema Único de Saúde, SUS, in Portuguese). Despite operating only during weekday business hours, outcomes were comparable to those of high-income countries. Expansion to 24-hour operation, infrastructure improvements, recruitment of additional healthcare professionals, and greater integration with the SUS remain key challenges.