A stroke can occur when an artery in the brain becomes blocked or when a blood vessel ruptures and causes bleeding. Stroke remains the second leading cause of death worldwide and the leading cause of acquired disability in adults. Despite this, recent decades have seen significant advances thanks to treatments such as intravenous thrombolysis and mechanical thrombectomy, which can restore blood flow to the brain in patients with ischaemic stroke when administered in time. For this reason, rapid diagnosis and treatment are essential to improving patient outcomes. However, there is another equally important lesson: to improve care, we must first measure it.
To ensure this rapid response, Catalonia launched the Stroke Code network in 2006, a coordinated system involving the Emergency Medical Service and specialist hospitals that has played a decisive role in improving care for this medical emergency.
The importance of measurement
In medicine, improvement begins with measurement. This is one of the key contributions of the Catalan Stroke Code Registry (CICAT). Over ten years, it systematically collected clinical and healthcare data from stroke cases treated across the region. These data have made it possible to evaluate outcomes, identify opportunities for improvement, and generate knowledge based on real-world clinical practice.
Over the last decade, Clínic Barcelona has treated an average of 2.2 stroke code activations every day. In total, this amounts to 8,085 registered stroke codes, approximately 11% of all cases recorded in Catalonia.
As a comprehensive stroke centre operating 24 hours a day, Clínic provides all available reperfusion therapies, including mechanical thrombectomy, and treats some of the most complex cases referred from across the region. Behind this activity is a multidisciplinary team working in a coordinated way to minimise treatment delays.
Data confirm the value of rapid treatment
The data collected over these years reinforce a principle well known to stroke specialists: acting quickly makes a difference.
According to CICAT data, Clínic achieves treatment times that are shorter than the average for comprehensive stroke centres in Catalonia, with a door-to-needle time of 26 minutes for intravenous thrombolysis and a door-to-groin puncture time of 61 minutes for mechanical thrombectomy. In fact, CICAT data place Clínic among the top-performing comprehensive stroke centres in Catalonia in key indicators such as treatment speed, functional recovery and mortality, for both thrombolysis and thrombectomy. Beyond the numbers, what truly matters is what they represent: greater chances of recovery, less disability and a better quality of life for many people.
Achieving these results is particularly significant for a tertiary referral centre that manages some of the most complex stroke cases. They are the result of coordinated work by neurology, emergency medicine, nursing, radiology, anaesthesiology, neurosurgery and many other teams, together with the Emergency Medical Service and referral hospitals within the network. These results also motivate us to continue improving.
Data that also generate knowledge
CICAT has not only served to evaluate healthcare quality. It has also become a highly valuable tool for clinical research. Registry data have supported studies on the impact of the COVID-19 pandemic on stroke care, the prognostic value of early neurological recovery, the effectiveness of thrombectomy in different patient groups, including those with severe strokes who were previously not considered likely to benefit from treatment, and the challenges involved in prehospital stroke recognition.
The greatest legacy of CICAT is that it has demonstrated that healthcare quality can be measured rigorously and transparently. These data are not just numbers; they are a tool for understanding what works, what can be improved and how to provide better care for people with stroke. We must preserve the quality and continuity of this information, because measuring healthcare activity rigorously remains one of the most effective ways to improve it. We must also broaden our focus to life after stroke: fatigue, cognitive difficulties, return to work and quality of life. Follow-up systems should help us better understand these needs and organise the support that patients require.
