“Leave No Stroke Behind”: Experts Discuss the Future of Stroke Care

WATCH TIME: 4 minutes | Captions are auto-generated and may contain errors.

In January 2026, the American Heart Association and American Stroke Association released updated guidelines for the management of acute ischemic stroke, highlighting the latest best practices in stroke care. Notably, these updates include guidance specific to pediatric patients, reflecting the unique challenges and considerations involved in treating children. Developed through extensive research and expert consensus, the recommendations aim to streamline and optimize rapid, evidence-based interventions across a variety of clinical settings.

To explore the practical impact of these updates, NeurologyLive® hosted a conversation with Beth Cavanaugh, MD, pediatric stroke neurologist and director of the Pediatric Stroke Program at Le Bonheur Children's Hospital, and Andrei Alexandrov, MD, professor and chair of the Department of Neurology at the University of Arizona College of Medicine–Phoenix. During the discussion, the clinicians covered several topics, including the pediatric considerations and the need for collaboration among pediatric specialists and adult stroke programs.

In this episode, Alexandrov and Cavanaugh touch on several key considerations shaping the future of stroke care, including evolving treatment approaches, improving systems for rapid evaluation, and the unique challenges clinicians may encounter when assessing stroke symptoms across different patient populations. Their conversation highlights how ongoing innovation and collaboration continue to influence the way clinicians think about stroke recognition and management.

This transcript is edited for clarity. Click here to view more of our stroke coverage.

Alexandrov, MD: I'm excited because right now, what is called stroke? It’s essentially every stroke that comes to the hospital. The emergency physicians are encouraged to call us if the onset is within 24 hours or unknown and that's essentially 90% of all patients who come to our emergency rooms. The answer to stroke treatment these days is recognition, as Dr. Cavanaugh pointed out, timely imaging, and contact with an expert.

What does imaging mean and what are the options? Is it systemic thrombolysis, thrombectomy or some other neurosurgical intervention? The options are becoming really, really diverse. Time is brain. The sooner you get there, the better. But regardless of the time delay, we're still looking to find patients with salvageable brains, that's the excitement.

Cavanaugh, MD: I think one thing that I have observed, at least through my early career, is not just the availability of the options, but finding the right patient for the right treatment. And I think a lot of times that has been something that I've seen—how do we select the best patients for the interventions out there? I'm really hopeful that this can both include more children and continue to redefine the patient population that benefits from these interventions.

Alexandrov, MD: The philosophy for approaching a stroke patient should be twofold: find reasons to treat, not excuses not to treat, and leave no stroke behind. The more treatment options available, and the more sophisticated our imaging selection tools become, the more in-depth evaluations we can offer patients.

Innovation comes in pre-hospital care; just look at the inclusion of mobile stroke units in the guidelines. Across all levels of hospitals, we’re encouraged to build hub-and-spoke relationships, and timely contact with the right expert is important. We have tools from cloud-based imaging to identifying hospitals that are stroke-ready and can perform multimodal imaging, and that progress is already encouraging.

Cavanaug, MD: And I think one thing I might mention about difficulties or barriers specifically with pediatrics, is that it can be a tricky population. Children who present with focal neurological deficits do have higher rates of stroke mimics. They can still be neurological emergencies that benefit from quick evaluation and contacting expertise in both pediatrics and stroke neurology.

But that's just one thing to keep in mind: you may see higher rates of mimics, but we're still improving the diagnostic yield when screening children who present with stroke-like symptoms. So, changing perspective—while not everything is a stroke in kids—they can still be neurological emergencies that benefit from early diagnosis.