New Stroke Guidelines Went Into Effect Aug. 3
We adopted the new 2026 AHA/ASA Acute Ischemic Stroke Guidelines across our organization on Monday, Aug. 3. All clinicians should be aware of several important changes that will affect stroke recognition, activation, and treatment.
Patients who present beyond the traditional 4.5-hour treatment window should no longer be assumed to be ineligible for intervention. Prompt Stroke Alert activation remains essential so the stroke team can determine treatment eligibility using current guideline recommendations and advanced imaging.
Key updates to the guidelines include:
- Continue to emphasize BEFAST recognition and activate a Stroke Alert immediately whenever stroke is suspected.
- Stroke Alerts should be activated for patients with a Last Known Well (LKW) of less than 24 hours.
- Selected patients may now be eligible for thrombolytic therapy and/or mechanical thrombectomy up to 24 hours after symptom onset when advanced imaging demonstrates appropriate eligibility.
- The updated guideline includes recommendations for pediatric stroke, recognizing that stroke can occur in children as well as adults.
- EMS routing recommendations support transport to endovascular thrombectomy-capable centers when appropriate.
More Details
Please review these resources for additional information:
- 2026 guidelines published on the AHA/ASA website
- Printable Carilion summary of the new guidelines (PDF)
Questions?
For clinical program questions and barrier escalations, contact:
- Stroke program medical directors Dr. Thomas Kodankandath or Dr. Biraj Patel
- Stroke program manager Pam Flinchum
For quality questions and barrier escalations, contact:
CAPS team members:
- System senior director Pam Booth
- Senior director Ashli Semones
- Director Savanah Caldwell
- Quality Improvement facilitator Chrystal Wilson
Regional facilities:
- CNRV: Vickie Rodgers
- CFMH: Kimberly Robertson
- CRBH: Finley Waddell
- CTCH: Alicia Bales
- CGCH: Jennifer Bailey
