ISC 2026 | AHA/ASA 2026 guideline on acute ischemic stroke: updates regarding systems of care

There’s some interesting things related to pre-hospital care, which is how do our systems work well together and what kind of approaches should we be taking. The first is that mobile stroke units, which are these ambulances that are outfitted with CT scanners and telemedical services to a stroke provider, they actually do much better than regular ambulance services in terms of identifying a stroke because they have a CT scanner, treating with thrombolysis in the ambulance itself, and so can do it much sooner. And that golden hour treatment, that early window of thrombolysis has been shown to markedly improve functional outcomes in those that were treated in a mobile stroke unit. So even though mobile stroke units are not widespread, they’re not everywhere, we think there’s evidence to recommend their use when possible in locations that can adopt them and include them in their system of care. The other system of care update is that we give some nuanced guidance on how to consider bypassing or taking a patient outside of their local stroke center hospital to a further one if there are certain criteria met. So if a system has a kind of inefficient local hospital that they’re not likely to be able to do thrombectomy and their processes of getting the patient to the next hospital are not exceptional, probably routing the patient to the comprehensive stroke center or the thrombectomy-capable center is wise because you’ll save time because you’ll bypass that inter-facility transport time. And that has, I think, some opportunities to improve outcomes because then those patients will get to a comprehensive stroke center or thrombectomy center, be able to get assessed and potentially treated with powerful therapies like endovascular treatment.

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