Guideline Updated for Early Management of Acute Ischemic Stroke

WEDNESDAY, Feb. 4, 2026 (HealthDay News) — In a guideline issued by the American Heart Association/American Stroke Association and published online Jan. 26 in Stroke, updated recommendations are presented for the early management of patients with acute ischemic stroke (AIS).

Shyam Prabhakaran, M.D., from the University of Chicago, and colleagues updated the guideline for the early management of patients with AIS to replace the 2018 guideline.

The authors note that mobile stroke units (MSU) enable rapid identification and treatment of thrombolytic-eligible patients with AIS and included recommendations relating to MSU implementation. For patients with suspected stroke in the prehospital setting, the guideline endorses consideration of the characteristics of the local system of care and direct transport to the closest endovascular thrombectomy (EVT)-capable hospital. For patients with AIS, intravenous thrombolysis is a mainstay of medical management; the new guideline endorses the use of either alteplase or tenecteplase in the 4.5-hour thrombolytic treatment window. Rapid thrombolytic treatment within the 4.5-hour window is recommended for eligible patients with disabling deficits, regardless of the National Institutes of Health Stroke Scale (NIHSS) score, without advanced imaging selection. The benefit of thrombolysis has not been demonstrated for patients with nondisabling deficits in the 4.5-hour window. EVT has been established as standard treatment for patients with AIS with large vessel occlusion and should be considered in patients previously considered ineligible. For patients with basilar artery occlusion presenting within 24 hours of symptom onset and with an NIHSS score ≥10, EVT is strongly recommended. Recommendations are also included for interventional treatment in pediatric patients with AIS.

“New recommendations in the guideline expand access to cutting-edge treatments, such as clot-removal procedures and medications, simplify imaging requirements so more hospitals can act quickly, and introduce guidance for pediatric stroke for the first time,” Prabhakaran said in a statement.

Several members of the Writing Committee and Peer Review Committee disclosed ties to the biopharmaceutical industry.

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