David Sahakyan, MD
General and Endovascular Neurosurgeon, Head of Cerebrovascular Neurosurgery Service, Erebouni Medical Center, Yerevan, Republic of Armenia

Stroke is the primary worldwide healthcare problem, especially for developing countries. Armenia was one of those countries, where the implementation of modern, time-sensitive stroke treatment modalities like intravenous thrombolysis and mechanical thrombectomy was insufficient and sometimes impossible due to the high cost and underdeveloped stroke care system. For years, neurologists and neurosurgeons willing to provide state-of-the-art treatment to stroke patients were unable to do so because patients and their families had to pay for the procedures and medications out of their pocket before the treatment could be delivered. 

Everything changed in 2019. A collective effort of stroke specialists from Armenia and abroad, combined with the willingness of the new government to recognize the disability burden imposed by this devastating disease, led to amazing transformations in stroke care for the entire country. A national stroke program developed by a group of stroke specialists from the United States, Canada, France, and Armenia and supported by governmental funding made modern acute stroke care accessible for everyone in need in Armenia. In a small country with a population of 3 million, out of 5000 annual ischemic stroke patients, more than 300 patients have received acute stroke treatment for free since the beginning of 2019. More than 240 intravenous rTPA and 120 endovascular thrombectomies have already been performed at two stroke centers. In patients who received treatment, marked reduction of morbidity and mortality was achieved. It is worth mentioning that the budget of the program is around $1 million US dollars. And this is just the beginning. Further development of the stroke network is on the way.

Armenia is an excellent example of how a small developing country with limited financial resources can develop a world-class stroke care system with the help of experienced specialists from developed countries, motivated local physicians, and a supportive government.