Overview

Each year about 795 000 people in the USA will experience a new or recurrent stroke. About 600 000 of these events are first attacks, and 185 000 are recurrent attacks. Of all the strokes, 87% are ischemic, 10% are intracranial hemorrhage and 3% are subarachnoid hemorrhage. On average, every 40s someone in the USA has a stroke. Significant disparities exist within the US population: each year women have 55 000 more strokes than men, blacks have almost twice the risk of first-ever stroke compared with whites and Mexican Americans have an increased incidence of intracranial hemorrhage and subarachnoid hemorrhage compared with non-Hispanic whites, as well as increased incidence of stroke and transient ischemic attack (TIA) at younger ages. In 2005, stroke accounted for about one of every 17 deaths in the USA or 143 579 individuals. Stroke ranks at number three among all causes of death, behind cardiovascular disease and cancer and is the leading cause of serious, long-term disability in the USA. The estimated direct and indirect cost of stroke for 2009 is $68.9 billion.1

Since the approval of intravenous tPA in 1995, a number of key initiatives supported by evidence-based medicine have led to the national, regional and local organization of previously fragmented stroke care into more specialized hospital-based and stroke systems of care. These initiatives in organized stroke care have dramatically altered the landscape for stroke patients and providers.

Many factors are driving the centralization of acute stroke care in the USA. The recent development of formal certification for stroke centers is both a cause and an effect of this push. The certification process is still in evolution, and many different organizations, including state legislatures, are involved. In addition, the relationship between primary stroke centers (PSCs, essentially intravenous tPA-capable facilities) and comprehensive stroke centers (CSCs, generally endovascularly capable facilities) is …