Updated Guideline on Early Management of Stroke in Adults and Children Published by ASA

January 27, 2026—The American Stroke Association (ASA) announced the publication of the 2026 guideline for the early management of patients with acute ischemic stroke (AIS). The major updates in the guideline include expanded eligibility for advanced stroke therapies and new recommendations for diagnosing and treating stroke in children and adults.

Shyam Prabhakaran, MD, et al published the guideline in Stroke.

The new guideline, which replaces the 2018 edition and its 2019 update, reflects new evidence in AIS care and 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, stated the ASA press release.

According to ASA, the guideline provides the first detailed recommendations for diagnosing and treating stroke in children. Additionally, it highlights new evidence supporting the use of tenecteplase and discusses the implementation of mobile stroke units to deliver care faster and reduce the risk of long-term disability.

As summarized in the ASA press release, the guideline includes the following with regard to the treatment of ischemic stroke in children:

• Intravenous alteplase may be considered within 4.5 hours for children aged 28 days to 18 years with disabling deficits.
• Mechanical thrombectomy may be effective for large-vessel blockages in children aged ≥ 6 years within 6 hours and may be reasonable for up to 24 hours after symptom onset if imaging shows salvageable brain tissue.

Additionally, the press release outlined the guideline updates on access to endovascular thrombectomy (EVT) as follows:

• EVT is now recommended in selected patients for up to 24 hours after symptom onset, even if imaging shows certain large core infarcts by Alberta Stroke Program Early CT Score.
• Eligibility for EVT now includes some patients with posterior circulation stroke.
• Some patients with mild or moderate preexisting disability may benefit in the first 6 hours after symptom onset.
• EVT is not routinely recommended for smaller blockages in medium or small arteries in the brain but may be considered in a clinical trial.