{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:31:23Z","timestamp":1787923883787,"version":"build-2784847793"},"reference-count":108,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Epidemiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peru faces a growing mismatch between the increasing burden of ischemic stroke and the health system's capacity to respond.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We aimed to systematically map the primary research literature on ischemic stroke in Peru using a socio-ecological framework, characterize the current evidence base, quantify key epidemiological outcomes, and identify critical knowledge gaps to inform a national research agenda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a scoping review using the SPIDER framework and searched four databases through April 2025. We included original primary studies of Peruvian participants of any age with ischemic stroke, including observational, interventional, qualitative designs, and case reports. Study selection and data extraction were performed in duplicate. Findings were narratively synthesized across socio-ecological levels (individual, interpersonal, organizational, community, and policy\/environmental). Key epidemiological outcomes were pooled using random-effects meta-analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1210 records, 119 studies were included (131,424 participants), with 75% conducted in Lima. Ischemic stroke represented 62% of all stroke cases; 44% were women. Overall mortality was 12%. Large-vessel atherosclerosis (27%) and cardioembolic (24%) were common etiologies, but undetermined causes remained the highest (30%). The pooled thrombolysis rate was 2.9%, with no reported access to mechanical thrombectomy in observational studies. Qualitative studies identified barriers to timely care, poor guideline adherence, caregiver burden, and centralization of services. Quality-improvement efforts showed limited impact. Community prevention and digital innovations were tested in small pilots without scale-up. Policy-level evaluation was scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Research regarding stroke in Peru has increased but remains geographically centralized and structurally misaligned with the national burden. Major gaps persist in diagnostic capacity, implementation research, rehabilitation, caregiver support, and policy evaluation. A nationally coordinated and regional distributed research and system-level strengthening of the stroke program are urgently needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      (\n                      <jats:ext-link>https:\/\/doi.org\/10.17605\/OSF.IO\/7WYX8<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fepid.2026.1926861","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:52:16Z","timestamp":1787921536000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ischemic stroke in Peru: a scoping review of trends, outcomes, and evidence gaps"],"prefix":"10.3389","volume":"6","author":[{"given":"Christoper A.","family":"Alarcon-Ruiz","sequence":"first","affiliation":[{"name":"Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]},{"name":"Unidad de Investigaci\u00f3n Para la Generaci\u00f3n y S\u00edntesis de Evidencias en Salud, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Gutierrez-Arratia","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lessly","family":"Concha-Quereval\u00fa","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Barrientos-Ventura","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Moreno-Arias","sequence":"additional","affiliation":[{"name":"Departamento de Enfermedades Neurovasculares y Metab\u00f3licas, Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Otiniano-Sifuentes","sequence":"additional","affiliation":[{"name":"Departamento de Enfermedades Neurovasculares y Metab\u00f3licas, Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Ecos","sequence":"additional","affiliation":[{"name":"Departamento de Enfermedades Neurovasculares y Metab\u00f3licas, Instituto Nacional de Ciencias Neurol\u00f3gicas","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Zunt","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Global Health, Medicine (Infectious Diseases), and Epidemiology, University of Washington","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Jaime","family":"Miranda","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney","place":["Sydney, NSW, Australia"]},{"name":"CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World stroke organization: global stroke fact sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int J Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0004559","DOI":"10.1371\/journal.pgph.0004559","article-title":"Incidence of cerebrovascular disease in Peru from 2015 to 2023","volume":"5","author":"Rodr\u00edguez","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"26331055241292600","DOI":"10.1177\/26331055241292600","article-title":"Ischemic stroke: pathophysiology and evolving treatment approaches","volume":"19","author":"Majumder","year":"2024","journal-title":"Neurosci Insights"},{"key":"B5","doi-asserted-by":"publisher","first-page":"102758","DOI":"10.1016\/j.eclinm.2024.102758","article-title":"Global, regional, and national burden of ischemic stroke, 1990\u20132021: an analysis of data from the global burden of disease study 2021","volume":"75","author":"Li","year":"2024","journal-title":"eClinicalMed"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6809","DOI":"10.1038\/s41598-023-33182-3","article-title":"Prevalence and incidence of stroke in Latin America and the Caribbean: a systematic review and meta-analysis","volume":"13","author":"Cagna-Castillo","year":"2023","journal-title":"Sci Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S1474-4422(23)00277-6","article-title":"Pragmatic solutions to reduce the global burden of stroke: a world stroke organization\u2013lancet neurology commission","volume":"22","author":"Feigin","year":"2023","journal-title":"Lancet Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"743732","DOI":"10.3389\/fneur.2021.743732","article-title":"Fighting against stroke in Latin America: a joint effort of medical professional societies and governments","volume":"12","author":"Martins","year":"2021","journal-title":"Front Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"104819","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104819","article-title":"Challenges of thrombolysis in a developing country: characteristics and outcomes in Peru","volume":"29","author":"Abanto","year":"2020","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.17372482","article-title":"Access to health in the periphery of Peru: a systematic review","volume":"6","author":"Ram\u00edrez Preciado","year":"2026","journal-title":"Rev InveCom"},{"key":"B11","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.jns.2017.02.027","article-title":"Addressing post-stroke care in rural areas with Peru as a case study. 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