Abstract Body: Introduction: Acute stroke care (ASC) is crucial to improve patient outcomes. In developing regions, optimizing resources is essential to enhance effectiveness of stroke careline networks. Sao Paulo State presents a unique challenge due to its territory and healthcare infrastructure. This study aims to analyze current and potential territorial coverage for expanding ASC. Hypothesis: We hypothesize that by systematically analyzing existing resources, mapping and designing 30-60 minutes isochrones, it is possible to identify catchment gaps in the system. This analysis could guide strategic expansions and adaptations to enhance ASC coverage. Methods: We conducted a comprehensive analysis of current public healthcare infrastructure across Sao Paulo State, focusing on essential resources for ASC - 24/7 CT scan, ICU, ERs with local or remote neurologist support. Geographic Information System technology was employed to create isochrones reflecting the accessibility of healthcare facilities within 30-60 minutes. We also considered the implementation of telemedicine, to expand coverage in underserved areas. Results: Our analysis revealed significant disparities in the availability of current stroke care resources across Sao Paulo State, with 150 beds on 23 stroke units currently operating. This finding represents a massive discrepancy from the estimated 900 stroke unit beds recommended in the state based upon Brazilian stroke careline ministerial ordinance that estimates 5 stroke beds per 200 stroke admission annually. Urban areas demonstrated heterogeneous coverage depending on the regional health department division, while rural and remote regions showed critical gaps, with limited access to 24/7 CT scans, neurological support, and ICU beds. The isochrone maps highlighted regions where the existing infrastructure (figure 1) could be optimized to improve coverage (figure 2). Potential adaptations, such as the deployment of telemedicine and strategic placement of stroke units, were identified as feasible solutions to bridge these gaps. Conclusions: The findings emphasize the importance of a targeted approach to expand ASC coverage in developing regions. By leveraging available resources and strategically implementing new technologies, Sao Paulo State can significantly improve its ASC network. This analysis provides a model that can be adapted for other regions facing similar challenges, ultimately contributing to better stroke outcomes in developing countries.