Reperfusion for Ischemic Stroke in Brazil’s SUS (2018–2025): Thrombolysis, Thrombectomy, Mortality, Costs, and Regional Inequities

Abstract

Background: Reperfusion therapies for acute ischemic stroke (AIS)—intravenous thrombolysis and mechanical thrombectomy—have expanded in Brazil’s Unified Health System (SUS) after key regulatory milestones, but system performance varies across regions.

Objective: To describe utilization, in-hospital mortality, length of stay, and hospital costs of reperfusion admissions for AIS in the SUS (2018–2025), and examine regional distribution and temporal trends.

Methods: Ecological, retrospective time series using SIH/SUS (DATASUS/TabNet). We included admissions with primary ICD-10 I63* and identified reperfusion procedures recorded on the same authorization (thrombolysis; thrombectomy). Outcomes were in-hospital death, mean length of stay, and reimbursed costs. Indicators included counts, proportions, and rates per 100,000 inhabitants (IBGE denominators). Year 2025 covers January–August.

Results: We identified 37,543 reperfusion admissions (2018–2025): 36,183 thrombolysis (96.4%) and 1,360 thrombectomy (3.6%). Thrombectomy first appeared in 2023 (n=37), expanded in 2024 (n=769), and remained high in 2025 (n=554, Jan–Aug). Overall in-hospital mortality was 10.6% (thrombolysis 10.4%; thrombectomy 16.3%). Mean length of stay was 8.1 days overall; for thrombectomy it decreased from 11.8 (2023) to 9.4 (2024) and 8.1 days (2025). Aggregate expenditure reached BRL 141.6 million (thrombolysis BRL 110.5m; thrombectomy BRL 31.1m). National reperfusion rates rose to 3.22/100,000 in 2024; thrombectomy reached 0.36/100,000.

Conclusions: Reperfusion for AIS expanded in the SUS, with rapid thrombectomy uptake from 2023 while thrombolysis remained predominant. Higher mortality with thrombectomy is consistent with indication/severity bias; length of stay decreased over time. Persistent regional disparities highlight the need to strengthen stroke networks, streamline inter-hospital transfers, and monitor process and cost-consequence indicators to support equitable scale-up.