The American Stroke Association (ASA) released the “2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke” on Monday, expanded eligibility for advanced stroke therapies and new recommendations for diagnosing and treating stroke in children and adults are among the major updates.
According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, stroke is now the #4 leading cause of death in the U.S. Every year, nearly 800,000 people in the U.S. have a stroke, and it is also a leading cause of serious, long-term disability. There are several types of strokes. Ischemic stroke is the most common type and occurs when blood flow to the brain is suddenly blocked in a vessel, usually by a blood clot.
The new guideline replaces the 2018 edition and its 2019 update to reflect a surge of new evidence in acute ischemic stroke care. It provides an evidence-based roadmap for health care professionals to recognize, diagnose and treat ischemic stroke, from prehospital recognition to hospital management and early recovery.
“This update brings the most important advances in stroke care from the last decade directly into practice,” said Shyam Prabhakaran, M.D., M.S., FAHA, chair of the writing group for the guideline and the James Nelson and Anna Louise Raymond Professor of Neurology and chair of the department of neurology at the University of Chicago Medicine. “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.”
Since the 2019 update, several landmark trials have transformed stroke care, including interventions for large vessel occlusion in the brain, clot-busting or clot-removal therapies, and streamlined hospital workflows. The 2026 guideline brings that progress together to standardize stroke care across hospitals of all sizes and ensure rapid, evidence-based treatment for every patient, regardless of where they live.
The guideline reinforces that outcomes depend on what treatments are provided to stroke patients and how quickly and efficiently they are delivered. From the first 9-1-1 call to hospital discharge, coordinated systems of care can be a key factor in preventing lifelong disability. The updated recommendations focus on enhancing those systems, accelerating the use of imaging techniques and medication delivery, and expanding access to advanced procedures like endovascular thrombectomy (EVT, the mechanical removal of a blood clot).
