In the event of a stroke, every minute without blood flow can affect the brain. A stroke is a medical emergency that happens when blood can’t reach part of the brain.
“The encouraging news is that stroke care keeps improving,” says Thomas Mattio, MD, a neurologist with Neuroscience Group and Medical Director of the ThedaCare Comprehensive Stroke Center.
Approximately 87% of strokes are ischemic. This means they’re caused by a clot that blocks a blood vessel in the brain. In early 2026, the American Stroke Association (ASA) released updated recommendations for how adults with acute ischemic stroke should be recognized, diagnosed and treated.
“These new insights reflect research and real-world experience, especially around faster diagnosis, better imaging and expanding the criteria for who can safely benefit from time-sensitive treatments,” Dr. Mattio says.
As we mark National Stroke Awareness Month, we’re diving into the new ASA guidelines.
Unpacking the Updated Ischemic Stroke Guidelines
1. Recognize more stroke symptoms more quickly — and always call 911
Then: Public education has long emphasized getting to the hospital quickly and calling 911 because earlier treatment improves outcomes. This is still the recommendation.
Now: The newest recommendations keep that urgency and ask bystanders to use an expanded BE FAST symptom checklist to help care teams better understand the stroke timeline.
The ASA also offers a simple, practical tip. If you’re going to the emergency room with stroke symptoms, try to have someone with you (or on a video call) to help confirm what’s “normal” for you and when symptoms began. “We can more precisely pinpoint when you were ‘last known well,’ and that’s really important,” Dr. Mattio says.
Understanding the change: These details help care teams more quickly evaluate and treat people who are experiencing strokes. This is the updated BE FAST stroke warning checklist:
- B — Balance: Look for sudden trouble with balance or coordination, such as dizziness or vertigo, trouble walking, stumbling, falling, “feeling drunk” when you’re not, or new clumsiness or inability to coordinate movements.
- E — Eyes: Watch for sudden vision changes, such as vision loss in one or both eyes, blurred or double vision, or a new “dark curtain” or missing area in the visual field.
- F — Face: Monitor for one side of the face drooping, an uneven smile or numbness on one side of the face.
- A — Arms: Assess for weakness or numbness in one arm (or leg), or arm drift (when one arm drops when holding up both).
- S — Speech: Look for slurred speech, trouble finding words, difficulty understanding speech, speaking nonsense or confusion that starts suddenly.
- T — Time: Call 911 right away. Also note the time symptoms started or when the person was last known well (last seen normal), because treatment options depend heavily on timing.
2. Use imaging to expand stroke care options
Then: Emergency teams aimed to confirm a stroke quickly, typically with a brain scan (CT or MRI) to rule out bleeding and decide if clot-focused treatments were safe.
Now: Updated guidance highlights using imaging strategically. This is not only to confirm an ischemic stroke, but also to identify who may still benefit from treatment even when more time has passed.
Understanding the change: Better imaging and streamlined workflows help match the right treatment to the right patient — without losing precious time.
“Some people will still benefit, even if they arrive for treatment outside the customary guidelines,” Dr. Mattio says.
3. Use clot-busting medication more
Then: For many years, IV alteplase (tPA) was the main clot-busting medication used for eligible patients. Speed to treatment remained essential. That’s still the case today.
Now: The 2026 recommendations incorporate newer evidence supporting tenecteplase (TNK) as a clot-busting option alongside alteplase. For many people, these medications are most effective when given within about four and a half hours of symptom onset.
“Now we know that these medications may still be effective even when we don’t know the onset of symptoms, or more time has passed,” Dr. Mattio says.
Understanding the change: Adding TNK recognizes an approach that helps more people get treated quickly.
4. Expanded criteria for who may benefit from mechanical clot removal
Then: Mechanical thrombectomy (a procedure that removes a clot with specialized devices) became a standard option for people with blood clots that block one of the brain’s major arteries.
Now: The updated recommendations reinforce that some people may benefit from clot removal even when they arrive later — sometimes up to 24 hours after symptoms begin — when imaging suggests there is still salvageable brain tissue.
Understanding the change: Research over the last decade has clarified that “time window” isn’t the whole story. Some people have salvageable brain tissue beyond the earliest hours.
Improving Stroke Care
At the heart of these new recommendations is hope. More people can be treated safely and more effectively, especially when communities and hospitals work together to move quickly.
“Recognizing symptoms and calling 911 right away can open the door to treatments that weren’t available just a few years ago,” Dr. Mattio says. “We can work together to save lives.”
