ESOC 2026 | Guideline updates at ESOC 2026: subarachnoid hemorrhage, post-stroke pneumonia, and blood pressure

So this year we had three new guidelines being presented and simultaneously published at ESOC. So these are very important guidelines. The first is the subarachnoid hemorrhage guideline. This is a huge effort. It is a very important guideline for clinical practice. Indeed, it is the first guideline from ESO on this topic, on the subarachnoid hemorrhage. We do have a guideline before on unruptured aneurysms, management of unruptured aneurysms, but now it is indeed all questions around the management of patients with subarachnoid hemorrhage. And it is a collaboration between ESO together also with, joined by the European Neurosurgical Society and also ESMIT, so the Neurointerventional Society. So we do have views from neurosurgery, from neurointervention and from stroke neurology. And together in the same guideline, it covers, as I said, all the main questions around the management of these patients. So I very much suggest everyone to read it and to see both the evidence-based guidelines and also the expert recommendations that were discussed really in depth during the development of this guideline by this multi working group members from different backgrounds and multi-society and multidisciplinary guideline.

So we also have a relevant guideline on management of post-stroke pneumonia, which is, of course, a very important question in all stroke units. And indeed, it’s very welcome that we have more guidance on that.

And another very important topic is blood pressure management. And so we decided to have a guideline really dedicated to this topic, both in ischemic stroke and in ICH. This guideline covers all aspects of blood pressure management during the acute phase. And so it is really very helpful as well. We have seen lots of trials and sometimes it is definitely difficult to keep up and synthesizing all the evidence. And so here you can find the evidence-based recommendations and also expert recommendations on the management of these patients.

We also gave a brief overview of a new ESO product, which is from the guideline board, which is the stroke evidence update. This is a new type of review. So we do have the, you know, the evidence-based guidelines, the grade-based guidelines that are developed according to the evidence, high-quality evidence available for the main fields in stroke. Then for topics for which high-quality evidence is lacking, but we do have to deal with these questions every day, we developed some years ago, recently, the white papers, which is a consensus statement on specific topics for which this high quality evidence is lacking. It is a Delphi process with a specific methodology. The methodology is published and we hope the first white papers slash consensus guidelines will be published still this year. And this will be the kind of still systematic reviews, but then with this Delphi process for expert recommendations and the large panel of diverse experts in each topic to give these recommendations and to reflect on what could be the best approach for each of these questions.

And now we have a new product. It has been published in February the 1st, which tries to fulfill a gap that is not filled in by any of these types of guidelines, which is the very recent evidence that has just been presented or just been published. And as we have seen in this conference, it’s really difficult to keep up with all these new studies being presented. And there’s, you know, different degrees of access from stroke clinicians to what has been published and presented very recently. And so this is a summary from the guideline board members also with some reflections and critical synthesis of what can be the gaps and the methodological problems and the main conclusions of these studies. These studies that are selected for this paper are based on the expected impact they may have on future recommendations, also on the methodological quality and the perception of the relevance of the question for clinical practice. And so the guideline board together in this consensus selects the main studies and we do provide tables with what are the conclusions of the study, what is the methodology, what may be the implications for future guidelines and for clinical practice. And so it is, we think, a very useful tool so that everyone can easily have access to the most recent evidence. And we know that this is being taken to clinical practice in many ways in the difficult decisions we have to make every day. And so having really a synthesis of this also help us in guiding future guidelines and also on helping clinicians worldwide to have access to this appraisal of recent publications. So we hope this will be an annual publication in the European Stroke Journal. We have this first edition published for 2025 and we hope early next year we can have again another review like this, the stroke evidence update for 2026. And we look forward also to hearing the inputs and opinions from all the clinicians that will read this paper on what can be improved or changed since it is a new format. So now we have these three different types of, let’s say, recommendations or evidence appraisal. So the guidelines, the white papers and the stroke evidence update annually.

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