Canada is a vast country with an aging population. Although trends in stroke incidence show stabilization in some reports and decline in others, the reported prevalence of people living with stroke continues to rise due to demographic aging as well as in younger populations.^{Reference Kamal, Lindsay, Côté, Fang, Kapral and Hill1} Optimizing transport times to hospitals is therefore a priority to ensure that time-sensitive interventions are delivered as early as possible for eligible acute ischemic stroke patients. Despite the large landscape, Canada currently has 205 stroke centers, of which 178 provide only intravenous thrombolysis (IVT) and just 27 offer endovascular treatment (EVT). These EVT-capable hospitals are clustered primarily in more accessible regions.

Geographic modeling uses computer simulations and theoretical frameworks to analyze spatial relationships between locations. This study applies these principles to identify areas with poor or no access to EVT for acute strokes across Canada. The present article reports on research by Kamal et al. who utilized the available data on reperfusion-ready centers to create a province-wise grid system based on land area as well as population. Detailed transport times were calculated from each of the components of patient flow-from the point of stroke onset to the nearest EVT-capable center.

The study showed that most Canadian regions have reasonable access to IVT. Only 0.63% of the Canadian population lacks thrombolysis access within 4.5 hours. However, about 13.5% of Canadians (5.15 million people) lack access to EVT within 6 hours, and the number increased to a staggering 42.66% for cutoffs within 3 hours. These delays have been shown to be significantly reduced by improving operational efficiency measured by door-in-door-out (DIDO) times. DIDO, a key measure of transfer efficiency, currently reaches up to 155 minutes in some areas but carries an ambitious national target of 45 minutes.^{Reference Kamal, Baradaran-Noveiri, Barrie, Holodinsky, St. Louis and Demchuk2}

This study is a sincere attempt at mapping Canadian access to stroke-ready centers. It shows the present statistics and also highlights the potential to improve nationwide stroke care by reducing DIDO times, enhancing transfer pathways and strategically expanding EVT services. Such modeling should inspire other countries seeking to strengthen preparedness and reduce delays in acute stroke care delivery.