Guidelines Promote Faster Diagnosis and Improved Imaging

Recent changes in stroke care are helping to enhance the aid provided to patients during this medical emergency, an expert with ThedaCare said. 

A stroke occurs when blood flow to the brain is stopped. In the event of a stroke, every minute without blood flow may affect the brain, said Dr. Thomas Mattio, a neurologist with Neuroscience Group and medical director of the ThedaCare Stroke Program. 

In early 2026, the American Stroke Association (ASA) released updated recommendations for how adults with acute ischemic stroke should be recognized, diagnosed and treated. About 87% of strokes are ischemic, the result of a blocked blood vessel in the brain. 

“These new insights reflect research and real-world experience, especially around faster diagnosis, better imaging and expanding the criteria for who can safely benefit from time-sensitive treatments,” Dr. Mattio said. “Much of this begins with people learning the signs of a stroke and sharing that information with their family and friends.” 

Strokes are most common in older adults. In recent years, stroke cases have climbed steadily among younger and middle-aged adults. 

“The encouraging news is that stroke care keeps improving,” Dr. Mattio said. “And there are opportunities to help reduce our likelihood of having a stroke – lose weight, quit smoking, consume less alcohol, exercise and control our blood pressure.”

Unpacking the Recommendations

The new guidelines include roles for family members, friends and bystanders as well as health care teams.

People are encouraged to recognize stroke symptoms quicker and always call 911. The enhanced recommendations ask bystanders to use an expanded BE FAST symptom checklist to help care teams better understand the stroke timeline. The updated BE FAST stroke symptom checklist includes:

• B – Balance: Look for sudden trouble with balance or coordination, such as dizziness or vertigo, trouble walking, stumbling, falling, a feeling of being drunk when you’re not or new clumsiness or an inability to coordinate movements.
• E – Eyes: Watch for sudden vision changes, such as vision loss in one or both eyes, blurred or double vision or a new dark curtain or missing area in the visual field.
• F – Face: Monitor for one side of the face drooping, an uneven smile or numbness on one side of the face.
• A – Arms: Assess for weakness or numbness in one arm or leg or arm drift (when one arm drops when holding up both).
• S – Speech: Look for slurred speech, trouble finding words, difficulty understanding speech, speaking nonsense or confusion that starts suddenly.
• T – Time: Call 911 right away. Also note the time symptoms started or when the person was last known to be well because treatment options depend heavily on timing.

The ASA also encourages a person going to the emergency room with stroke symptoms have someone with them or on a video call to help confirm what their normal behavior is and when the person’s symptoms started.

“We can more precisely pinpoint when you were last known to be well and that’s important,” Dr. Mattio said. “These details may help care teams more quickly evaluate and treat people who are experiencing a stroke.”

The recommendations encourage using imaging to expand stroke care options. Traditionally, emergency teams aimed to confirm a stroke with a brain scan to rule out bleeding and decide if clot-focused treatments were safe. Now, the ACA recommends strategic use of imaging to confirm an ischemic stroke and identify who may still benefit from treatment even when more time has passed.

“The rationale is that better use of imaging and streamlined workflows may help improve efforts to match the appropriate treatment to the right patient without losing precious time,” Dr. Mattio said. “In other words, some people will still benefit, even if they arrive for treatment outside the customary guidelines.”

The other recommendations include:

• More use of clot-busting medication: For many years, IV alteplase (tPA) was the main clot-busting medication used for eligible patients. The 2026 recommendations incorporate newer evidence supporting tenecteplase (TNK) as a clot-busting option alongside alteplase. For many people, these medications are most effective when given within about four and a half hours of symptom onset. “Now we know that these medications may still be effective even when we don’t know the onset of symptoms or more time has passed,” Dr. Mattio said. “Adding TNK recognizes an approach that may help more people get treated quickly.”
• Expanded criteria for who may benefit from mechanical clot removal: Mechanical thrombectomy is a procedure that uses special devices to remove a clot. It became a standard option for people with blood clots that block one of the brain’s major arteries. The updated recommendations reinforce that some people may benefit from clot removal even when they arrive later – sometimes up to 24 hours after symptoms begin – when imaging suggests there is still salvageable brain tissue. Research over the last decade has clarified that time window isn’t the whole story. Some people have salvageable brain tissue even beyond the earliest hours.

At the heart of these new recommendations is hope, Dr. Mattio explained. More people can be treated safely and more effectively, especially when communities and hospitals work together to move quickly.

“Recognizing symptoms and calling 911 immediately may open the door to treatments that weren’t available just a few years ago,” he said. “We can work together to save lives.”

To learn more about ThedaCare’s stroke care, visit ThedaCare Neurology & Stroke.

About ThedaCare

For more than 115 years, ThedaCare® has been improving the health and well-being of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 650,000 residents in 17 counties, and employs approximately 7,000 providers and team members at 180 points of care, including 10 hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care. ThedaCare also partners with communities to understand needs, find solutions together, and encourage health awareness and action. ThedaCare is part of Froedtert ThedaCare, Wisconsin’s most comprehensive health care system.