Pakistan faces a growing stroke crisis with an incidence of 250 per 100,000 and over 560,000 new cases annually. Access to intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains critically limited, contributing to preventable disability and economic loss.

We reviewed national survey data, published literature, and stroke policy reports from Pakistan. Epidemiological and economic estimates were extrapolated using WHO, GBD, and MT-GLASS data. Stroke care capacity was mapped using facility reports and training program data.

Pakistan loses an estimated 1.5–2 million DALYs annually to stroke, with stroke-related economic costs exceeding USD $1 billion per year, representing ~1.5% of the national GDP. Approximately 63,500 patients annually are eligible for MT, yet only four centers currently offer this therapy. There are only six IVT-capable hospitals and ~10 stroke units nationally, with one neurologist per million population and no formal neurointerventional training programs. Major barriers include poor public awareness, lack of EMS stroke triage, inadequate infrastructure, and out-of-pocket expenses for acute stroke therapies. Proposed interventions include: 1) development of a national stroke registry; 2) establishment of regional MT and IVT centers via hub-and-spoke models; 3) launch of tele-stroke networks; 4) implementation of EMS “Code Stroke” protocols; 5) public stroke awareness campaigns; and 6) national insurance coverage for reperfusion therapies.