ESO East Supplement 2023 - 16

1103943
research-article2022
ESO0010.1177/23969873221103943European Stroke JournalTopcuoglu and Ozdemir
ESO EAST Project Supplement
Acute stroke management in Turkey:
Current situation and future projection
Mehmet Akif Topcuoglu1 and Atilla Ozcan Ozdemir2
Abstract
In Turkey, the incidence of acute stroke is increasing, obviously with the contribution of the aging population. With
the publication of " Directive on Health Services to be Provided to Patients with Acute Stroke " on July 18, 2019 and its
entry into force in March 2021, an important period of catching up and updating has begun in the management of acute
stroke patients in our country. During this period, 57 comprehensive stroke centers and 51 primary stroke centers were
certified. These units have covered approximately 85% of the country's population. In addition, around 50 interventional
neurologists were trained and became the directors of many of these centers. In the following 2 years, the " inme.org.
tr campaign " was launched. This campaign, aimed at increasing the public's knowledge and awareness about stroke,
continued unabated during the pandemic period. Now is the time to continue the efforts to ensure homogeneous quality
metrics and to develop and continuously improve the established system.
Keywords
Acute stroke, thrombolytic, tPA, thrombectomy, stroke center, stroke unit, vascular neurologist
Date received: 3 April 2022; accepted: 10 May 2022
Stroke epidemiology in Turkey
Turkey's population is approximately 86 million, corresponding
to almost 1% of the world's population. It is appropriate to
add the immigrants, mainly from Syria and Afghanistan
exceeding 5 million, to this number. Three quarters of the population
live in cities, and approximately 7.5% of them are
65 years or older. Average life expectancy is 75.6 years for men
and 81.2 for women.1 With the development of the welfare
level in Turkey, life expectancy has been getting longer in
recent years. With the contribution of this, the frequency of
stroke has been increasing gradually. In Turkey, the incidence
of ischemic stroke is 93.2-108.6 per hundred thousand, intracerebral
hemorrhage is 31.5-39.7, and total stroke is 141.7-
158.2 In Turkey, there were 435,941 deaths in 2019. The most
common cause for mortality was cardiovascular diseases
(36.8%), and stroke ranks second place (22.2%) after coronary
syndromes in this subgroup. Stroke is the third most common
cause of mortality in women and fourth in men. From 2002 to
2017, stroke mortality increased by 56%.3
Directive on health services to be
provided to patients with acute stroke:
Publication and entry into force in
Turkey
The fact that acute stroke is treated with intravenous tissue
plasminogen activator (IV tPA) and/or neurointerventional
methods, which can only be applicable within a certain
period of time, requires a referral and management system
that should cover the majority of the country. On the basis of
this reality, the " Directive on Health Services to be Provided
to Patients with Acute Stroke " was published by Turkish
Ministry of Health on July 18, 2019.4 While it was expected
to take effect a year later, it was postponed to March 2021
due to the pandemic. Afterward, 57 comprehensive stroke
centers (named as " Stroke Center " ) and 51 primary stroke
centers (named as " Stroke Unit " ) were certified in the
approximately 1-year period from March 2021. The distribution
of centers within the country is shown in Figure 1.
Organization of stroke system of care
in Turkey
In the Annex-1 of this directive, hospitals involved in in
acute stroke system of care in Turkey are organized in two
categories as " stroke units " and " stroke centers. "
1Department of Neurology, Hacettepe University, Ankara, Turkey
2Department of Neurology and Interventional Neurology, Osmangazi
University, Eskisehir, Turkey
Corresponding author:
Mehmet Akif Topcuoglu, Department of Neurology, Hacettepe
University, Medical Faculty Hospitals, Gate 9, Floor 3, Sıhhiye, Ankara
06230, Turkey.
Email: matopcuoglu@yahoo.com
European Stroke Journal
2023, Vol. 8(1S) 16 -20
© European Stroke Organisation 2022
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/23969873221103943
journals.sagepub.com/home/eso
https://doi.org/10.1177/23969873221103943

http://www.sagepub.com/journals-permissions https://www.doi.org/10.1177/23969873221103943 http://journals.sagepub.com/home/eso http://www.inme.org.tr http://www.inme.org.tr

ESO East Supplement 2023

Table of Contents for the Digital Edition of ESO East Supplement 2023