The guideline is endorsed by major organizations and highlighted as an educational tool by the American Academy of Neurology.

Care coordination and outcome tracking via the Get With The Guidelines—Stroke Registry, along with telemedicine and established transfer agreements, aim to improve survival and reduce disability.

The 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke expands eligibility for endovascular thrombectomy (EVT) and endorses clot-dusting medications like tenecteplase to accelerate treatment and reduce disability.

Key treatment updates allow EVT up to 24 hours after onset in select patients, with expanded eligibility for posterior circulation strokes and consideration of treatment for some patients with mild preexisting disability within early time windows.

Pediatric guidance expands EVT eligibility and provides dedicated pediatric stroke guidance to standardize care across ages, emphasizing rapid MRI/MRA diagnosis and recognizing adult tools may not apply to children.

Pediatric recommendations stress rapid MRI/MRA, acknowledge limitations of adult screening tools for kids, and outline IV thrombolysis within 4.5 hours and mechanical thrombectomy for select pediatric cases.

Clot-busting drugs tenecteplase or alteplase are endorsed within 4.5 hours, with tenecteplase offering a simpler single-dose approach, and treatment may be effective up to 24 hours in certain cases guided by imaging.

Imaging guidance emphasizes MRI with MRA when feasible, CT as a fallback when MRI isn’t timely, and ASPECTS scoring in facilities without advanced perfusion imaging.

The guideline calls for rapid, standardized care from prehospital recognition to discharge, endorsing imaging-based decision-making and simultaneous administration of clot-busting therapy and thrombectomy when appropriate.

Quality-improvement tools like the Get With The Guidelines-Stroke Registry are promoted to monitor treatment times and outcomes, alongside telemedicine expansion and broader imaging access to improve care.

It stresses fast prehospital and in-hospital workflows, including aiming for a brain scan within about 25 minutes of arrival, with imaging-driven decisions potentially extending treatment windows.

The guideline introduces the first detailed pediatric stroke recommendations, outlining diagnostic approaches and treatment options for children, including imaging strategies and possible use of IV alteplase and EVT in select cases.