The American Heart Association and American Stroke Association released an updated guideline on March 31 that expands treatment recommendations for acute ischemic stroke in both adults and children. The update, the first since 2019, introduces new protocols involving imaging, catheter-based procedures, and a greater role for emergency responders.
The expanded guidelines are significant because they increase the number of patients eligible for life-saving interventions. Nestor Gonzalez, MD, director of the Neurovascular Laboratory in the Department of Neurosurgery at Cedars-Sinai and co-vice chair of the group that developed the guideline, said rapid response is critical: “Stroke is one of the most time-sensitive emergencies in medicine. The faster we restore blood flow to the brain, the more brain function we can preserve.”
One major change allows more patients to receive endovascular clot-removal procedures up to 24 hours after stroke onset—an increase from previous criteria that limited most treatments to within six hours. The new guidance also includes patients with large-core strokes or preexisting disabilities who may benefit from intervention. Gonzalez said recent studies support expanding these treatments: “Since the previous stroke guidelines were published in 2019, new clinical trials have expanded our understanding of which patients can benefit from these treatments.”
For pediatric care, this is the first national guidance dedicated specifically to treating strokes in children. Gonzalez explained its importance: “Stroke can occur at any age, including in children. However, because it is rare, clinicians may not immediately consider stroke when a child presents with sudden neurological symptoms.” He added that specialized centers applying adult endovascular techniques to pediatric cases have seen promising outcomes.
The guidelines emphasize system-wide improvements such as coordinated emergency response teams and telemedicine support for smaller hospitals so all patients—especially children—can be diagnosed and treated quickly at specialized centers like Cedars-Sinai Medical Center.
Cedars-Sinai Medical Center has been serving Los Angeles since its founding in 1902 under current president Thomas M. Priselac; it admitted over 50,000 patients according to their 2022 annual report.
Looking ahead at research directions inspired by these changes, Gonzalez said his work focuses on improving surgical bypass techniques for conditions like Moyamoya disease and adapting them for adults with intracranial atherosclerosis: “Early clinical trials have shown encouraging results…we are working to expand those studies to multiple centers to determine whether the technique can improve outcomes for patients who currently have limited treatment options.”
