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Clinical Practice Guidelines Registry — Stroke

Last curated: 2026-08-30

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 This registry catalogs major current and superseded stroke guidelines by document lineage.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. Every PMID below was retrieved through live PubMed E-utilities on 2026-08-30. Web-only guideline pages were fetched on the same date.

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current (aging) = newest located but its evidence base is ≥5 years old or has material post-publication evidence; superseded by → = formally replaced by the named document; adjacent = focused standard or consensus that complements rather than replaces a broad guideline; living =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 PMID 31662037 superseded by → #1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 PMID 25156220 superseded by → #9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

Coverage count: 31 documents or maintained guideline sets: 26 current/current-aging/focused/adjacent/framework rows, 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.

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.
  • 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.

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.

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

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. ICH surgery. Technique, anatomy and timing produce conditional recommendations; “surgery recommended/not recommended” without those qualifiers is not a faithful summary.
  6. 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).
  7. Restarting anticoagulation after ICH. Ischemic indication, hemorrhage mechanism and imaging phenotype create a tradeoff that no broad guideline resolves for every patient.
  8. PFO closure. The ESO 2024 scope is PFO after stroke; it does not endorse screening or closure of incidental PFO (Caso 2024, PMID 38752755).
  9. Covert SVD antiplatelets. ESO recommends against aspirin solely for covert lesions despite broader cardiovascular familiarity with aspirin; evidence is sparse (Wardlaw 2021, PMID 34414301).
  10. 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).
  11. 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).
  12. 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 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
Multilingual national-guideline sweep current coverage is not geographically representative national ministry/society sites plus PubMed by country/language

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.
  • 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.