2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南血管内治疗要点与解读Interpretation of the Key Updates on Endovascular Therapy in the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association

急性缺血性卒中（acute ischemic stroke，AIS）是全球致死、致残的重要原因，再灌注治疗是急性期改善患者预后的关键措施。2026年1月，2026美国心脏学会/美国卒中学会AIS患者早期管理指南正式发布，对相关推荐进行了更新，本文围绕血管内治疗（endovascular therapy，EVT）部分进行解读。2026版指南在延续前循环近端大血管闭塞患者既有证据的基础上，进一步明确了延长时间窗EVT的影像学入选标准，并对大梗死核心及卒中前已存在功能受限的AIS患者给出了更清晰的EVT筛选条件；同时，对后循环卒中，尤其是基底动脉闭塞，依据其临床严重程度和影像学损伤程度对治疗决策进行了分层。值得注意的是，2026版指南首次系统纳入了儿童AIS的EVT推荐，为不同年龄与时间窗儿童患者的临床决策提供了参考框架。Acute ischemic stroke (AIS) is a major global cause of death and disability, with reperfusion therapy being crucial for improving outcomes in the acute phase. In January 2026, the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association was officially released, updating relevant recommendations. This article provides an interpretation focused on the endovascular therapy (EVT) section. Building on existing evidence for patients with proximal anterior circulation large vessel occlusion, the 2026 guideline further clarifies imaging eligibility criteria of EVT within the extended time window and delineates more explicit selection criteria of EVT for AIS patients with large ischemic cores and pre-stroke functional impairment. In addition, for posterior circulation stroke, particularly basilar artery occlusion, the 2026 guideline stratifies decision-making basis according to clinical severity and the extent of imaging-defined injury. Notably, the 2026 guideline systematically includes EVT recommendations in pediatric AIS for the first time, providing a reference framework for clinical decision-making in pediatric patients across different age groups and time windows.