April 2026 Recall: Topics on Vascular Neurology

The April 2026 Neurology Recall episode delivers a high-impact synthesis of the latest advances in vascular neurology, centered on the transformative 2026 AHA-ASA guidelines for acute ischemic stroke. The episode reveals that mechanical thrombectomy is now recommended for patients with large ischemic cores and even up to 24 hours from last known well—shattering previous time and imaging constraints. A key breakthrough is the validation of CT perfusion-based selection for extended-window thrombolysis in non-LVO patients, with trials like OPTION showing a 3% absolute improvement in excellent outcomes when patients have a large penumbra and small core. The episode also highlights the landmark CATALYST study, which demonstrates that starting anticoagulation within four days after ischemic stroke and atrial fibrillation is not only safe but reduces recurrent ischemic events—challenging long-held fears of hemorrhage. Despite these advances, the field still grapples with persistent disability: half of patients remain disabled at discharge, underscoring the urgent need for neuroprotective therapies. The episode closes with a call to action: the stroke community must now focus on optimizing systems of care, refining protocols for late-presenting patients, and advancing trials like SELECT-LATE and ATLAS to extend treatment windows further. The episode’s most compelling insight is that reperfusion—opening the blocked vessel—is the single most powerful intervention in stroke care.