Improvements in Time-Sensitive Stroke Care and Alteplase Administration: The Iranian Comprehensive Code Stroke Management Program (Icsm Phase Iii) Publisher Pubmed



Alijanpour S ; Bahramnezhad F ; Mowla A ; Shifteh S ; Hadinezhad Z ; Khafri S ; Dehghan Nayeri N
Source: Stroke Published:2026

Abstract

BACKGROUND: – Timely management of acute stroke in the emergency medical services setting is critical. Systemic challenges in this phase include the absence of evidence-based standards, inconsistent protocols, and coordination delays. This study aimed to implement and evaluate an updated national stroke protocol in northern Iran. METHODS: – This quasi-experimental study evaluated the Iranian Comprehensive Code Stroke Management Program. The intervention group (Babol emergency medical services, n=248) received a multi-faceted empowerment program, while the control group (Mazandaran emergency medical services, n=900) received standard training. Patients' level outcomes were assessed on prehospital time, monthly intravenous alteplase counts, and administration rates before (March–September 2023) and after the intervention (March–September 2024). RESULTS: – Of 1131 suspected stroke codes, 400 (35%) were hospital-confirmed. The intervention significantly reduced most prehospital time intervals (except transport time) and increased the rate of intravenous alteplase administration per hospital-confirmed stroke code from 13.94% preintervention to 39.49% postintervention (absolute increase +25.55%±19.17; P<0.001). Additionally, the mean monthly number of alteplase administrations showed an increasing trend (+4.00±4.64; P=0.07). Conversely, the control group exhibited a significant decrease in the mean number of monthly alteplase administrations (−0.72±0.57; P=0.04) and a nonsignificant reduction in the administration rate (−1.49 percentage points; SD ±6.47; P=0.69). CONCLUSIONS: – Implementing the updated protocol was associated with significant reductions in critical time intervals and a near-tripling of the intravenous alteplase administration rate in the intervention group. National evaluation should include long-term functional outcomes to confirm effectiveness and establish its value as a model. © 2026 American Heart Association, Inc.