Clinical Practice Guidelines Registry — Stroke¶
Last curated: 2026-10-27
Purpose. This registry catalogs major current and superseded stroke guidelines by document lineage. It records documents, scope, provenance, contribution and replacement status; recommendation synthesis belongs in ../../wiki/guidelines.md. current means the newest located document in its lineage as of the curation date, not that every recommendation incorporates evidence published up to that date. Base entries were verified on 2026-08-30; later additions have their own sweep provenance in LOG.md. The new rehabilitation correction was resolved through E-utilities and Crossref on 2026-10-27; the relevant web update pages were read that day.
Status key. current = newest document in that body/scope lineage; current (aging) = newest located but its evidence base is ≥5 years old or has material post-publication evidence; superseded by → = formally replaced by the named document; adjacent = focused standard or consensus that complements rather than replaces a broad guideline; living = maintained at recommendation level online.
1. Master table¶
| # | Society / body | Year | Region | Scope | Citation + PMID/URL | Status |
|---|---|---|---|---|---|---|
| 1 | AHA/ASA | 2026 | USA | Early management of acute ischemic stroke (AIS), prehospital through early secondary prevention | Prabhakaran et al. Stroke. 2026;57:e316–e436. PMID 41582814 | current |
| 2 | AHA/ASA | 2019 | USA | AIS early management update | Powers et al. Stroke. 2019;50:e344–e418. PMID 31662037 | superseded by → #1 |
| 3 | AHA/ASA | 2024 | USA | Primary prevention across the life course | Bushnell et al. Stroke. 2024;55:e344–e424. PMID 39429201 | current |
| 4 | AHA/ASA | 2021 | USA | Secondary prevention after ischemic stroke/TIA | Kleindorfer et al. Stroke. 2021;52:e364–e467. PMID 34024117 | current (aging) |
| 5 | AHA/ASA | 2022 | USA | Spontaneous intracerebral hemorrhage (ICH) | Greenberg et al. Stroke. 2022;53:e282–e361. PMID 35579034 | current |
| 6 | AHA/ASA | 2023 | USA | Aneurysmal subarachnoid hemorrhage (aSAH) | Hoh et al. Stroke. 2023;54:e314–e370. PMID 37212182 | current |
| 7 | ESO | 2021 | Europe | Intravenous thrombolysis for AIS | Berge et al. Eur Stroke J. 2021;6:I–LXII. PMID 33817340 | current (aging) |
| 8 | ESO–ESMINT | 2019 | Europe | Mechanical thrombectomy for AIS | Turc et al. Eur Stroke J. 2019;4:6–12. PMID 31165090 | current (aging) |
| 9 | ESO–EANS | 2025 | Europe | Spontaneous ICH | Steiner et al. Eur Stroke J. 2025;10:1007–1086. PMID 40401775 | current |
| 10 | ESO | 2014 | Europe | Spontaneous ICH | Steiner et al. Int J Stroke. 2014;9:840–855. PMID 25156220 | superseded by → #9 |
| 11 | ESO | 2019 | Europe | Reversal of oral anticoagulants in acute ICH | Christensen et al. Eur Stroke J. 2019;4:294–306. PMID 31903428 | adjacent; current (aging) |
| 12 | ESO | 2025 update (published 2026) | Europe | Blood-pressure management in AIS and ICH | Sandset et al. Eur Stroke J. 2026;11. PMID 42095756 | current focused update |
| 13 | ESO–EANS–ESMINT | 2026 | Europe | Aneurysmal SAH | Vergouwen et al. Eur Stroke J. 2026;11. PMID 42095754 | current |
| 14 | ESO | 2013 | Europe | Intracranial aneurysms and SAH | Steiner et al. Cerebrovasc Dis. 2013;35:93–112. PMID 23406828 | superseded by → #13 |
| 15 | ESO | 2019 | Europe | Antithrombotic secondary prevention in non-valvular AF after stroke/TIA | Klijn et al. Eur Stroke J. 2019;4:198–223. PMID 31984228 | current (aging) |
| 16 | ESO | 2021 | Europe | Carotid endarterectomy and stenting | Bonati et al. Eur Stroke J. 2021;6:I. PMID 34414303 | current |
| 17 | ESO | 2021 | Europe | Extracranial and intracranial artery dissection | Debette et al. Eur Stroke J. 2021;6:XXXIX–LXXXVIII. PMID 34746432 | current |
| 18 | ESO | 2024 | Europe | PFO diagnosis and management after stroke | Caso et al. Eur Stroke J. 2024;9:800–834. PMID 38752755 | current |
| 19 | ESO | 2021 | Europe | Covert cerebral small-vessel disease | Wardlaw et al. Eur Stroke J. 2021;6:CXI–CLXII. PMID 34414301 | current |
| 20 | ESO / VASCERN | 2023 | Europe | Moyamoya angiopathy | Bersano et al. Eur Stroke J. 2023;8:55–84. PMID 37021176 | current |
| 21 | ESO / EAN | 2017 | Europe | Cerebral venous thrombosis | Ferro et al. Eur J Neurol. 2017;24:1203–1213. PMID 28833980 | current (aging) |
| 22 | Heart & Stroke / Canadian Stroke Best Practices | 2022 update (journal 2024) | Canada | Acute stroke management | Heran et al. Can J Neurol Sci. 2024;51:1–31. PMID 36529857 | current |
| 23 | Canadian Stroke Best Practices | 2020 update (journal 2022) | Canada | Secondary prevention | Gladstone et al. Can J Neurol Sci. 2022;49:315–337. PMID 34140063 | current (aging) |
| 24 | Canadian Stroke Best Practices | 2020 update (journal 2021) | Canada | Spontaneous ICH | Shoamanesh et al. Int J Stroke. 2021;16:321–341. PMID 33174815 | current (aging) |
| 25 | Canadian Stroke Best Practices | 2019 update (journal 2020) | Canada | Rehabilitation and recovery | Teasell et al. Int J Stroke. 2020;15:763–788. PMID 31983296 | current (aging) |
| 26 | Canadian Stroke Best Practices | 2019 update (journal 2020) | Canada | Mood, cognition and fatigue | Lanctôt et al. Int J Stroke. 2020;15:668–688. PMID 31221036 | current (aging) |
| 27 | NICE NG128 | 2019, updated 2022 | England | Stroke/TIA diagnosis and initial management in people >16 | NICE, https://www.nice.org.uk/guidance/ng128, accessed 2026-08-30 | current web guideline |
| 28 | Stroke Foundation | living | Australia | Full stroke management continuum | InformMe, https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management, accessed 2026-08-30 | living |
| 29 | World Stroke Organization | 2014 | Global / resource-stratified | Global Stroke Services Guidelines and Action Plan | Lindsay et al. Int J Stroke. 2014;9 Suppl A100:4–13. PMID 25250836 | current framework (aging) |
| 30 | AHA/ASA | 2026 | USA | Adult stroke rehabilitation and recovery | Richards et al. Stroke. 2026. PMID 42657476 | current; replaces 2016 |
| 31 | SVIN | 2026 | USA / focused | EVT for distal and medium-vessel occlusion | Majidi et al. Stroke Vasc Interv Neurol. 2026;6:e002314. PMID 42404835 | current focused guideline |
| 32 | Neurocritical Care Society / SCCM | 2026 | USA / focused | Treatment of antithrombotic-associated intracranial hemorrhage (spontaneous and traumatic) | Vallejo et al. Neurocrit Care. 2026. PMID 42786382 | current focused update of the 2016 NCS/SCCM document |
| 33 | Neurocritical Care Society | 2026 | USA / focused | Seizure prophylaxis in aneurysmal SAH | Rowe et al. Neurocrit Care. 2026;45:445–463. PMID 42552475 | current focused guideline |
| 34 | China ICAS Research Group | 2026 | China | Diagnosis and treatment of intracranial atherosclerotic stenosis | Leng et al. Int J Stroke. 2026;21:1182–1195. PMID 41568775 | current national guideline |
| 35 | WSO / APSO / PAVIN | 2026 | Asia | ICAS definitions, diagnosis and imaging (modified Delphi consensus) | Navarro et al. Cerebrovasc Dis. 2026. PMID 42758665 | adjacent consensus |
| 36 | Spanish Society of Neurology Stroke Study Group | 2026 | Spain | Palliative care in stroke | Ximénez-Carrillo et al. Neurologia (Engl Ed). 2026;41:502035. PMID 42190798 | current national guideline |
| 37 | AHA | 2026 | USA | Health literacy and communication across stroke prevention, management and recovery (scientific statement) | Mogos et al. Stroke. 2026. PMID 42877955 | adjacent scientific statement |
| 38 | World Stroke Organization | 2026 | Global | Vascular contribution to dementia (scientific statement) | Biessels et al. Int J Stroke. 2026;21:1211–1234. PMID 42454751 | adjacent scientific statement |
| 39 | AHA/ASA | 2026 | USA | Correction to adult stroke rehabilitation/recovery guideline | Richards et al. Stroke. 2026;57:e700–e701. PMID 42932410 | companion erratum to #30; content not retrieved |
Coverage count: 39 documents or maintained guideline sets (including 1 companion erratum): 33 current/current-aging/focused/adjacent/framework rows (rows 32–38 added 2026-10-20), 3 superseded entries, 1 web guideline and 1 living system; rows count documents, not individual recommendations.
2. Guideline-family entries¶
2.1 AHA/ASA acute ischemic stroke: 2019 → 2026¶
- Current citation: Prabhakaran S, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2026;57:e316–e436. PMID 41582814.
- Superseded citation: Powers WJ, et al. 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019;50:e344–e418. PMID 31662037.
- Scope: prehospital evaluation, emergency diagnosis, thrombolysis, thrombectomy, supportive care, early complications and initiation of early secondary prevention.
- Unique contribution of 2026: explicitly replaces both 2018 and 2019; adds evidence on thrombolytic choice/eligibility, EVT selection, hyperglycemia, dysphagia, pediatric populations and contraindications. Literature search ran September–December 2024 with selected additions through March 2025.
- Version hazard: the 2026 correction is PubMed-indexed separately (Prabhakaran et al. Stroke. 2026;57:e461–e467. PMID 42507797); implementers should consult the corrected version rather than copying an early PDF. A separate article titled "Proposed Corrections to the 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke" was published by Albers et al. (Stroke. 2026;57:2935–2938. PMID 42535283). PubMed carries no abstract for it, and its content was not retrieved in the 2026-10-20 sweep, so which recommendations it disputes is not recorded here.
2.2 AHA/ASA prevention¶
- Primary prevention: Bushnell C, et al. Stroke. 2024;55:e344–e424. PMID 39429201. Replaces the 2014 primary-prevention guideline; adds life-course and sex-specific screening/prevention domains and aligns risk-factor recommendations with Life's Essential 8.
- Secondary prevention: Kleindorfer DO, et al. Stroke. 2021;52:e364–e467. PMID 34024117. Broad mechanism-specific prevention after stroke/TIA, including antithrombotics, AF, vascular disease, lipids, blood pressure, behavior and systems supporting adherence.
- Boundary: the primary document applies to people without prior stroke; the secondary document applies after stroke/TIA. Using one as a substitute for the other changes baseline risk, evidence and net-benefit calculations.
2.3 AHA/ASA hemorrhagic stroke¶
- Spontaneous ICH: Greenberg SM, et al. Stroke. 2022;53:e282–e361. PMID 35579034. Covers emergency care, blood pressure, anticoagulant reversal, surgery, neurocritical complications, prognosis, rehabilitation and recurrence prevention.
- Aneurysmal SAH: Hoh BL, et al. Stroke. 2023;54:e314–e370. PMID 37212182. Replaces the 2012 lineage; covers prevention, diagnosis, transfer, aneurysm treatment, delayed cerebral ischemia, neurocritical care and recovery.
- Boundary: neither document governs traumatic hemorrhage. ICH and aSAH are not interchangeable guideline populations.
2.3a AHA/ASA adult rehabilitation: 2016 → 2026¶
- Current citation: Richards LG, et al. 2026 Guideline for Adult Stroke Rehabilitation and Recovery. Stroke. 2026. PMID 42657476.
- Superseded citation: Winstein CJ, et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016;47:e98–e169. PMID 27145936.
- Scope: the recovery continuum, comorbidities, fracture and fall prevention, technology-enabled rehabilitation, caregiver support, participation, and safe return to work and driving.
- Correction retrieved 2026-10-27: Richards LG, et al. Correction to: 2026 Guideline for Adult Stroke Rehabilitation and Recovery: A Guideline From the American Heart Association and American Stroke Association. Stroke. 2026;57:e700-e701. PMID 42932410. PubMed identifies it as an erratum to the 2026 guideline; Crossref lists the correction on 2026-10-26. Its text was inaccessible, so the changed recommendations are not characterized.
- Search boundary: the writing group searched literature from the 2016 guideline through October 2025; publication on 2026-08-27 does not incorporate later evidence automatically.
2.4 ESO acute ischemic stroke¶
- IV thrombolysis: Berge E, et al. Eur Stroke J. 2021;6:I–LXII. PMID 33817340. GRADE document with systematic reviews, formal recommendations and expert consensus. High-certainty recommendations include alteplase within 4.5 hours and selected wake-up stroke with MRI DWI–FLAIR mismatch when thrombectomy is not planned.
- Mechanical thrombectomy: Turc G, et al. Eur Stroke J. 2019;4:6–12. PMID 31165090. High-certainty support for MT plus best medical management within 6 hours and moderate-certainty support at 6–24 hours for trial-matched patients.
- Aging flag: both predate the full evidence base incorporated into AHA/ASA 2026. They remain current in their lineages but should be paired with ESO expedited recommendations and updates when a question has moved.
2.4a SVIN focused distal/medium-vessel thrombectomy guidance¶
- Citation: Majidi S, et al. Endovascular Thrombectomy in Medium and Distal Vessel Occlusions. Stroke Vasc Interv Neurol. 2026;6:e002314. PMID 42404835.
- Scope: adult acute ischemic stroke from distal- or medium-vessel occlusion, with literature searched through February 2026.
- Boundary: the guideline does not support routine EVT for DMVO on current randomized evidence, while considering EVT reasonable for selected disabling dominant-M2 occlusion; it is a focused statement, not a replacement for the broad AHA/ASA or ESO thrombectomy lineage.
2.5 ESO ICH: 2014 → 2025, plus focused modules¶
- Current broad document: Steiner T, et al. ESO–EANS guideline on stroke due to spontaneous ICH. Eur Stroke J. 2025;10:1007–1086. PMID 40401775.
- Superseded broad document: Steiner T, et al. ESO guideline for spontaneous ICH. Int J Stroke. 2014;9:840–855. PMID 25156220.
- Oral-anticoagulant reversal module: Christensen H, et al. Eur Stroke J. 2019;4:294–306. PMID 31903428.
- Blood-pressure module: Sandset EC, et al. 2025 update to ESO guideline on BP management in AIS and ICH. Eur Stroke J. 2026;11. PMID 42095756.
- Use rule: the 2025 broad guideline controls the lineage; focused documents may supply detail but should be checked for consistency and date.
2.6 ESO aneurysmal SAH: 2013 → 2026¶
- Current: Vergouwen MDI, et al. ESO–EANS–ESMINT guideline on aneurysmal SAH. Eur Stroke J. 2026;11. PMID 42095754.
- Superseded: Steiner T, et al. European Stroke Organization guidelines for intracranial aneurysms and SAH. Cerebrovasc Dis. 2013;35:93–112. PMID 23406828.
- Unique contribution: the 2026 document is jointly owned by stroke, neurosurgical and minimally invasive therapy societies, making procedural and multidisciplinary interpretation explicit.
2.7 ESO mechanism-specific prevention and uncommon stroke¶
| Topic | Citation | Verified distinctive boundary |
|---|---|---|
| AF after stroke/TIA | Klijn et al. 2019. PMID 31984228 | DOACs preferred over vitamin K antagonists for eligible non-valvular AF; timing and restart after ICH remain weak-evidence areas |
| Carotid stenosis | Bonati et al. 2021. PMID 34414303 | compares endarterectomy, stenting and medical therapy; procedural risk and timing are integral |
| Artery dissection | Debette et al. 2021. PMID 34746432 | extracranial and intracranial dissections addressed separately from atherosclerosis |
| PFO after stroke | Caso et al. 2024. PMID 38752755 | applies after stroke and causal workup; not a population-screening guideline |
| Covert small-vessel disease | Wardlaw et al. 2021. PMID 34414301 | recommends BP control and against aspirin solely for covert disease; direct evidence sparse |
| Moyamoya angiopathy | Bersano et al. 2023. PMID 37021176 | much advice is low-certainty or expert consensus; presentation and hemodynamic impairment guide revascularization |
| Cerebral venous thrombosis | Ferro et al. 2017. PMID 28833980 | recommends acute parenteral anticoagulation and decompression for herniation risk; multiple post-acute questions unresolved |
2.8 Canadian Stroke Best Practices¶
- Acute management: Heran M, et al. Can J Neurol Sci. 2024;51:1–31. PMID 36529857. The seventh-edition 2022 update connects prehospital, emergency, imaging, thrombolysis, EVT, inpatient complications, early rehabilitation, end-of-life and virtual care; new material includes tenecteplase and bridging therapy.
- Secondary prevention: Gladstone DJ, et al. Can J Neurol Sci. 2022;49:315–337. PMID 34140063.
- Spontaneous ICH: Shoamanesh A, et al. Int J Stroke. 2021;16:321–341. PMID 33174815.
- Rehabilitation/recovery: Teasell R, et al. Int J Stroke. 2020;15:763–788. PMID 31983296.
- Mood/cognition/fatigue: Lanctôt KL, et al. Int J Stroke. 2020;15:668–688. PMID 31221036.
- Implementation site: Canadian Stroke Best Practices, https://www.strokebestpractices.ca/, fetched 2026-08-30 (HTTP 200). The site supplies recommendation text and implementation resources beyond the journal summaries.
2.9 NICE NG128¶
- Document: NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NG128, published 2019, updated 2022. https://www.nice.org.uk/guidance/ng128, fetched 2026-08-30 (HTTP 200).
- Scope: recognition, specialist assessment, imaging, acute ischemic treatment and early management; it is not the complete UK rehabilitation guideline.
- Version behavior: online recommendations and history are authoritative; cite the access date and recommendation section because web text can change without a new journal citation.
2.10 Australian living guideline¶
- Document: Stroke Foundation. Living Clinical Guidelines for Stroke Management. https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management, fetched 2026-08-30 (HTTP 200).
- Scope: prevention and the full management/recovery continuum in a recommendation-level living format.
- Unique contribution: targeted recommendations can be updated independently rather than waiting for a whole-edition cycle.
- Version hazard: extracts require access date/version metadata; “the Australian guideline says” is insufficient provenance for a mutable recommendation.
- 2026-10-27 content check: the update page lists dysphagia and weakness/electrical-stimulation drafts under public consultation from 24 September to 30 October 2026. These are pending recommendations, not adopted changes. The page's latest listed finalized update is 26 August 2026 (Stroke Foundation — “Living guidelines updates”, https://informme.org.au/guidelines/living-guidelines-updates, accessed 2026-10-27).
2.11 World Stroke Organization resource-stratified framework¶
- Citation: Lindsay P, et al. World Stroke Organization global stroke services guidelines and action plan. Int J Stroke. 2014;9 Suppl A100:4–13. PMID 25250836.
- Scope: organizes stroke service capability and actions by resource level.
- Unique contribution: supplies a staged system-development framework for settings unable to implement every comprehensive-center element at once.
- Aging flag: useful architecture, but specific acute-treatment capabilities and evidence have changed substantially since 2014.
2.12 Additions from the 2026-10-20 sweep (rows 32–38)¶
- NCS/SCCM antithrombotic-associated ICH (row 32). A GRADE focused update covering five PICO questions, producing eight recommendations. All are conditional: 4F-PCC rather than andexanet for factor-Xa-inhibitor effects; no platelet transfusion for non-neurosurgical spontaneous intraparenchymal hemorrhage on antiplatelets; platelet transfusion for spontaneous hemorrhage on aspirin when surgery is planned; and viscoelastic assays to guide coagulopathy treatment in traumatic ICH. No recommendation was possible on desmopressin, on platelet transfusion in traumatic ICH, or on reversal in small hemorrhages. Source: the PubMed abstract.
- NCS aSAH seizure prophylaxis (row 33). The recommendations rest on 10 studies. Antiseizure prophylaxis "may" or may not be used (conditional, low quality). If used, levetiracetam or phenytoin/fosphenytoin (very low quality), for short or long duration (moderate quality). Source: verified in the Europe PMC full text.
- Chinese ICAS guideline (row 34). For symptomatic ICAS: intensive medical management, with short-term dual antiplatelet therapy in high-risk patients, LDL-C <1.8 mmol/L, BP <140/90 mm Hg and HbA1c <7.0%. Endovascular treatment is not recommended below 70% stenosis and may be considered for selected medically refractory 70–99% stenosis, preferably more than 21 days after stroke. Routine aspirin or endovascular treatment is not recommended for asymptomatic ICAS.
- WSO/APSO/PAVIN ICAS consensus (row 35). 23 Delphi recommendations from 17 experts, agreement threshold ≥80%, defining ICAS as ≥50% luminal narrowing and standardizing diagnostic evaluation and transcranial-Doppler screening. Definitions only, not treatment.
- Spanish palliative-care guideline (row 36). Covers communication, goals of care, decision-making and symptom management in severe stroke, graded with the ACC/AHA 2016 classification.
- Scientific statements (rows 37–38). These synthesize evidence and research priorities rather than issuing graded recommendations. They are catalogued as adjacent so they are not mistaken for guidelines.
3. Supersession graph¶
| Lineage | Verified chain | Operational consequence |
|---|---|---|
| AHA/ASA AIS | 2018 guideline → 2019 update (PMID 31662037) → 2026 replacement (PMID 41582814) + 2026 correction (PMID 42507797) | retire 2019-only order-set citations; check corrected 2026 text |
| AHA/ASA primary prevention | 2014 → 2024 (PMID 39429201) | use 2024 life-course and sex-specific recommendations |
| AHA/ASA aSAH | 2012 → 2023 (PMID 37212182) | retire 2012 procedural and complication-management text |
| AHA/ASA adult rehabilitation | 2016 (PMID 27145936) → 2026 (PMID 42657476) | use the 2026 continuum, participation and technology recommendations; retain 2016 only historically |
| ESO ICH | 2014 (PMID 25156220) → ESO–EANS 2025 (PMID 40401775) | retain 2014 only for historical comparison |
| ESO aSAH | 2013 (PMID 23406828) → joint ESO–EANS–ESMINT 2026 (PMID 42095754) | use multidisciplinary 2026 document |
| Canadian acute management | 2018 sixth edition (PMID 30021503) → 2022 seventh-edition update (PMID 36529857) | new protocol work should use the seventh edition |
No supersession is inferred across different bodies. A newer AHA/ASA document does not formally “supersede” an ESO document; it may simply contain a later evidence cutoff.
4. Documented disagreements and gaps¶
- Thrombolytic choice and population. AHA/ASA 2026 explicitly updates thrombolytic choice and eligibility, while the broad ESO IVT document is from 2021 and describes tenecteplase as an area needing further randomized evidence (Prabhakaran 2026, PMID 41582814; Berge 2021, PMID 33817340). Apparent disagreement must be dated.
- Direct EVT versus bridging thrombolysis. ESO–ESMINT defines best medical management as including IV thrombolysis when indicated and identifies direct-EVT strategy as an evidence gap (Turc 2019, PMID 31165090). Later guidance should be checked by presentation route and eligibility rather than generalized.
- Large-core, distal/medium-vessel and low-NIHSS EVT. These populations evolve faster than broad guideline cycles. The 2026 SVIN focused guideline does not support routine DMVO EVT but preserves a selected disabling dominant-M2 boundary (Majidi 2026, PMID 42404835); search cutoff, occlusion definition and disability outcome must accompany any summary.
- ICH blood-pressure target. AHA/ASA 2022, ESO–EANS 2025 and the 2025 ESO BP update overlap but do not have identical publication cutoffs or phrasing (PMIDs: 35579034, 40401775, 42095756).
- ICH surgery. Technique, anatomy and timing produce conditional recommendations; “surgery recommended/not recommended” without those qualifiers is not a faithful summary.
- Anticoagulation timing after AF-related infarct. ESO 2019 explicitly labels timing evidence weak even while preferring DOACs over vitamin K antagonists for eligible patients (Klijn 2019, PMID 31984228).
- Restarting anticoagulation after ICH. Ischemic indication, hemorrhage mechanism and imaging phenotype create a tradeoff that no broad guideline resolves for every patient.
- PFO closure. The ESO 2024 scope is PFO after stroke; it does not endorse screening or closure of incidental PFO (Caso 2024, PMID 38752755).
- Covert SVD antiplatelets. ESO recommends against aspirin solely for covert lesions despite broader cardiovascular familiarity with aspirin; evidence is sparse (Wardlaw 2021, PMID 34414301).
- CVT currency. The current located ESO/EAN guideline is from 2017 and explicitly leaves duration, endovascular treatment and several seizure questions unresolved (Ferro 2017, PMID 28833980).
- Rehabilitation precision. The 2026 AHA/ASA update broadens current recovery guidance, but many dose and sequencing questions remain lower-certainty than acute reperfusion thresholds (Richards 2026, PMID 42657476; Teasell 2020, PMID 31983296).
- Factor-Xa-inhibitor reversal in ICH. The NCS/SCCM 2026 focused update conditionally prefers 4F-PCC to andexanet (Vallejo 2026, PMID 42786382). The AHA/ASA 2022 ICH guideline predates ANNEXA-I, and this condition's ICH page summarizes ANNEXA-I as better hemostasis with more thrombosis. Where documents with different search dates diverge, record the date with the recommendation.
- aSAH seizure prophylaxis. AHA/ASA 2023 considers short-course prophylaxis in higher-risk phenotypes (Hoh 2023, PMID 37212182). NCS 2026 leaves use or non-use to the clinician on low-certainty evidence (Rowe 2026, PMID 42552475).
- Global coverage. This registry overrepresents English-language, PubMed-indexed North American and European bodies. National guidelines in Asia, Latin America, Africa and the Middle East require a dedicated multilingual sweep before absence can be claimed.
5. Watch list¶
| Item to watch | Why | Retrieval route |
|---|---|---|
| AHA/ASA 2026 AIS corrigenda and focused clarifications | correction already published; early implementation can propagate errors | PubMed query Prabhakaran acute ischemic stroke guideline correction; AHA professional guideline page |
| ESO IV thrombolysis update | 2021 document predates later tenecteplase and subgroup evidence | ESO guideline directory; PubMed query ESO thrombolysis guideline |
| ESO–ESMINT thrombectomy update | 2019 broad document predates large-core and distal-vessel evidence | ESO guideline directory; Eur Stroke J |
| AHA/ASA secondary prevention replacement | 2021 evidence base is aging | AHA professional guidelines; Stroke |
| AHA/ASA adult rehabilitation corrigenda and implementation tools | 2026 replacement was indexed on 2026-08-27 | PubMed query adult stroke rehabilitation guideline; AHA professional guideline page |
| ESO factor XI inhibitor expedited recommendation | directory lists it as in development on 2026-10-27; do not imply OCEANIC-STROKE has already entered adopted guidance | https://eso-stroke.org/guidelines/eso-guideline-directory/ |
| ESO AF-after-stroke update | timing and restart questions explicitly unresolved in 2019 | Eur Stroke J; ESO guideline directory |
| ESO/EAN CVT update | 2017 document predates later anticoagulant trials | Eur J Neurol; ESO directory |
| Canadian modules | web recommendations and journal editions can have different update dates | https://www.strokebestpractices.ca/ |
| NICE NG128 surveillance | online recommendations can change between journal summaries | https://www.nice.org.uk/guidance/ng128/history |
| Australian living recommendations | recommendation-level updates do not wait for editions | https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management |
| Resource-stratified global framework | 2014 WSO service tiers predate modern thrombectomy access standards | WSO publications; PubMed query World Stroke Organization stroke services guideline |
| Patient/public involvement reporting | influence and representativeness are rarely quantified | methods supplements and panel disclosures |
| Albers et al. proposed corrections to AHA/ASA 2026 AIS | content not retrieved on 2026-10-20; check whether AHA/ASA issues a further correction | PubMed PMID 42535283; Stroke |
| Multilingual national-guideline sweep | current coverage is not geographically representative | national ministry/society sites plus PubMed by country/language |
2026-10-27 directory check: ESO lists an expedited recommendation on factor XI inhibitors in development (ESO — “ESO Guideline Directory”, https://eso-stroke.org/guidelines/eso-guideline-directory/, accessed 2026-10-27). The Australian consultation and AHA/ASA rehabilitation erratum above are the actionable currency findings from this sweep; neither is synthesized as an adopted new treatment recommendation.
6. Curation limits¶
- PubMed verifies indexed documents and metadata; it does not establish that a society has not issued a newer web-only update.
- AHA professional pages returned HTTP 403 to automated fetch on 2026-08-30; AHA/ASA document identity and status above therefore rest on the live PubMed records.
- ESO directory, Canadian Stroke Best Practices, NICE NG128 and Australian InformMe pages returned HTTP 200 on 2026-08-30. All four returned HTTP 200 again on 2026-10-20. Their recommendation content was not re-read, so no web-only update is claimed or excluded.
- The 2026-08-30 audit re-fetched every PMID, checked the summarized scope against the indexed record, re-ran dated guideline searches, and verified the web guideline endpoints. It did not extract and compare every recommendation table inside every full guideline; recommendation-level reuse still requires consulting the named edition and corrigenda.
- The registry omits documents whose identity or status could not be established rather than partially cataloguing them.
Registry maintained under CONVENTIONS.md §3. Recommendation synthesis: ../../wiki/guidelines.md.