The American Heart Association/American Stroke Association’s 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke (AIS) replaces the 2018 guideline and 2019 update. The guidance provides the most current, comprehensive, evidence‑based recommendations for the early management of AIS, spanning prehospital evaluation, acute treatment, early in‑hospital management of complications, and initiation of secondary prevention. Developed through a literature search of research published from 2018 to December 2024, with high‑impact studies added through March 2025, the guideline incorporates major advances in thrombolytic agent selection and eligibility, updated criteria for endovascular thrombectomy, and new evidence guiding the management of hyperglycemia and dysphagia. It also adds focused considerations for pediatric AIS and revises the approach to thrombolysis contraindications. The guideline authors acknowledge major progress but also point to persistent knowledge gaps, emphasizing that continued research is needed to further refine and strengthen acute ischemic stroke treatment approaches.