2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke
Published: January 26, 2026
- Every year in the United States, >600,000 individuals have a first ischemic stroke and approximately 200,000 more have a recurrent stroke. More than 9 million Americans age 20 years and older self-report having had a stroke, with an overall prevalence estimated at 3.3%.
- The prevalence of stroke in the United States continues to increase with the aging population. It is estimated that by 2030 an additional 3.4 million US adults (3.9% of the adult population) will have had a stroke, representing an increase of >20% from 2012.
- This guideline updates the 2018 Acute Ischemic Stroke Guideline and its 2019 update. Key changes include endorsement of mobile stroke units, refined EMS triage, expanded use of tenecteplase within 4.5 hours, broader eligibility for endovascular thrombectomy, and the first recommendations for pediatric acute ischemic stroke.
Message from the Writing Group Chairs for the 2026 Acute Ischemic Stroke Guideline
Writing Group Chair Shyam Prabhakaran, MD, MS, FAHA and Co-Vice Chairs Nestor R. Gonzalez, MD, MSCR, FAHA and Kori S. Zachrison, MD, MSc, FAHA review some of the major changes to the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke.
Supporting Materials
- Top Things to Know: 2026 Guideline for the Early Management of Patients With AIS
- News Release: New Guideline Expands Stroke Treatment for Adults offers First Pediatric Stroke Guidance
- Top Take-Home Messages for the Emergency Physician
- Guidelines in Action: Dual Anti-Platelet Therapy for Non-Disabling Stroke within the 4.5-hour Window
- Guidelines in Action: Flight of the Mobile Stroke Unit
- Guidelines in Action: Getting to the (Large) Core of the (T)Issue
- Guidelines in Action: General Supportive Early Management: Blood Pressure and Glucose
- Guidelines in Action: Basilar Artery Occlusion and Thrombectomy
- Guidelines in Action: Extending the Treatment Window for Thrombolysis in Acute Ischemic Stroke
- Guidelines in Action: Pediatric Acute Ischemic Stroke Treatments (Thrombolysis and Thrombectomy)
Clinical Update Slides & Infographics
- 2026 AIS Guideline Essentials Clinical Slide Series
Download 2026 AIS Guideline Essentials Clinical Slide Series - Stroke Nursing Slide Set for the 2026 AIS Guideline
Download Stroke Nursing Slide Set for the 2026 AIS Guideline - Infographic - Pediatric Stroke Readiness
Download Pediatric Stroke Readiness Infographic - Infographic: Pediatric Stroke Alert Pathway
Download Pediatric Stroke Alert Pathway Infographic
Recommended Reading
- Creating Virtual Stroke Networks: Current and Future Role of Artificial Intelligence, Mobile Imaging Applications, and Telehealth in Triage and Treatment of Acute Ischemic Stroke
- Ideal Foundational Requirements for Stroke Program Development and Growth
- Large-Core Ischemic Stroke Endovascular Treatment
- Identifying Best Practices for Improving the Evaluation and Management of Stroke in Rural Lower-Resourced Settings