Abstract Background and aims Cambodia has experienced marked economic growth, with annual GDP growth of 5–6% and GDP per capita reaching USD 2,755 in 2024; however, it remains a low- to middle-income country. Reports on stroke care in such settings are limited. We report a single-center experience of stroke treatment in Cambodia. Methods We retrospectively analyzed 1,698 stroke patients requiring hospitalization between October 2016 and December 2025 at a medium-sized hospital in Phnom Penh equipped with one of the few biplane angiography systems in the country. Particular focus was placed on 78 surgically treated subarachnoid hemorrhage (SAH) cases and 28 acute ischemic stroke cases treated with mechanical thrombectomy. Results Successful reperfusion after thrombectomy was achieved in 75% of cases, with a mean door-to-reperfusion time of 155 minutes. An mRS ≤3 at 90 days was observed in 52%, and hemorrhagic complications occurred in 14%. Intravenous t-PA was administered in 28%. In SAH patients, the mean age was 58.5 years, 55% were female, and anterior communicating artery aneurysms were most common (46%). WFNS grade I accounted for 67%. Coil embolization was performed in only 6%. Mean hospital stay was 19 days, and onset-to-arrival time averaged 69.4 hours. Nicardipine was associated with reduced vasospasm (OR 0.86, p=0.041). An mRS of 0–2 at discharge was achieved in 68%. Conclusions Despite global reliance on endovascular therapy, cost remains a major barrier in Cambodia, limiting treatment access. Stroke care capacity and operator training remain insufficient, highlighting the need for structured training systems, including overseas programs. Conflict of interest Name of author: nothing to disclose
Ryosuke Kaneko (2026) studied this question.