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Ossama Mansour: First Resource Stratified Guidelines for Acute Ischemic Stroke in the MENA Region
Ossama Mansour/LinkedIn
Mar 18, 2026, 15:18

Ossama Mansour: First Resource Stratified Guidelines for Acute Ischemic Stroke in the MENA Region

Ossama Mansour, Chief Executive Officer of a Semoha University Campus, Faculty of Medicine at Alexandria University, shared on LinkedIn about a recent article by Ossama Yassin et al, adding:

“We are proud to highlight the publication of the first comprehensive, resource-stratified guidelines for acute ischemic stroke management in the Middle East and North Africa an initiative that represents years of collaborative work by 45 multidisciplinary experts from 22 countries, published in Neurological Research (2026).

Why does this matter?

The MENA region bears a disproportionate stroke burden.

Approximately 75% of stroke-related deaths worldwide occur in low- and middle-income countries.

In our region, strokes strike nearly a decade earlier than in Western populations (mean age 58–62 vs. 68–72 years), against a backdrop of high diabetes prevalence (8–20%), hypertension (26–38%), and smoking rates exceeding 50% in men.

Yet until now, clinical guidance has been directly transplanted from Western or East Asian evidence – often without accounting for our geography, culture, healthcare infrastructure, conflict realities, or economic constraints.

What these guidelines deliver:

Using the MENA-SINO systematic seven-step adaptation framework and adhering to AGREE II standards, the expert panel synthesized evidence from AHA/ASA, ESO, NICE, and Chinese Stroke Association guidelines alongside 186 regional publications.

Through three rounds of modified Delphi consensus achieving more than 85% agreement, the guidelines introduce:

  • A tiered (3-level) hub-and-spoke stroke care system adapted to MENA realities
  • The ‘Drip and Ship’ model with MENA-specific ’30-Minute Rule’ for urban traffic
  • Tenecteplase as the preferred thrombolytic for resource-limited settings (single bolus advantage)
  • Clear EVT guidance for large core infarcts, basilar artery occlusion, and medium vessel occlusions
  • Culturally sensitive decision-making frameworks including family-centered consent and Ramadan-specific protocols
  • Conflict zone and refugee population management strategies
  • Secondary prevention tailored to regional risk factor patterns, including ICAD-specific DAPT protocols
  •  Cost-effectiveness analyses guiding resource prioritization

The numbers that drive urgency:

  • Door-to-needle time regional benchmark: currently 145 minutes target: less than 60 minutes
  • IVT rate in eligible patients: currently only 12% target: more than 60% for Tier 2 centers
  • Stroke mortality in conflict zones: up to 65%
  • Mechanical thrombectomy available in fewer than 30% of stroke-receiving hospitals

These guidelines are a living document.

They call upon Ministries of Health, international organizations, research institutions, and every neurologist, emergency physician, and nurse in the region to act because time is brain, and our patients deserve evidence that speaks their language.

Overflowing with pride and a deep sense of gratitude, I feel incredibly fortunate to stand shoulder to shoulder with this powerhouse constellation of regional experts a brilliant league of minds united by one bold mission: to revolutionize stroke care across our region.”

Title: MENA-adapted guidelines for acute ischemic stroke management: a regional approach to global evidence

Authors: Ossama Yassin, Mohamad Ezzeldin, May Nour, Ameer Hassan, Syed F Zaidi, Mouhammad A Jumaa, Farid Aladham, Ibrahim Alnaami, Hosam Maher Al-Jehani, Abdulrahman Alshamy, Faisal Alghamdi, Atilla Ozcan Ozdemir, Tamer Hassan, Hany Zaki Eldeen, Hany Hamadani, M Shazam Hussain, Ehsan Sharifipour, Erdem Gurkas, Mohamed Alaa Habib, Nadia Hammami, Hosam Salah, Farouk Hassan, Syed I Hussain, Yahia Imam, Seby John, Adnan Qureshi, Amina El Khamlichi, Amr Mahmoud, Ahmed Ossama, Mostafa Mahmoud, Ehab S Mohamed, Nada Nasr, Umair Rashid, Salma Said, Abdulmonem Saied, Maher Saqqur, Khalid Sobh, Mohammed Wasay, Mohammed Ghorbani, Jeyaraj Pandian, Adnan Siddiqui, Ashfaq Shuaib

Read the Full Article on Neurological Research 

Ossama Mansour: First Resource Stratified Guidelines for Acute Ischemic Stroke in the MENA Region

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