Stroke unit (SU) care increases the proportion of patients who survive strokes without dependency [1], irrespective of stroke subtypes, age, sex, and baseline severity [1]. This benefit was proven before that of aspirin [2], [3], intravenous (i.v.) thrombolysis [4], [5], mechanical thrombectomy (MT) [6], and decompressive surgery in cerebral ischaemia, and rapid reduction of systolic blood pressure below 140 mmHg in spontaneous cerebral haemorrhages [7]. For 100 patients managed in SU, the net benefit is 2 survivors, 6 patients living at home, and 6 additional independent survivors [1]. Based on this evidence, the French high authority for health (Haute Autorité de Santé, HAS) recommended that all patients with stroke are admitted in a SU [8], [9]. Subsequently, 2 governmental directives defined SU as units dedicated to stroke care, open 24 hours a day, with a multidisciplinary and specialised staff [10], [11]. They also defined SU as the association of (i) an intensive care stroke unit (I-SU) for emergency diagnosis and treatment, with a specific funding through a daily fee [11], and (ii) a non-intensive stroke unit (NI-SU) to complete the diagnostic work-up, initiate or continue secondary prevention measures, and start rehabilitation when needed [10], [11]. These governmental directives led to a 2-fold increased proportion of patients treated in SU between 2009 and 2014 [12].

The aim of this study was to evaluate (i) resources available in French SU, (ii) differences between regions, and between France, Germany, and Italy, and (iii) to identify avenues for improvement.