The guidance will also require healthcare professionals to take into account people's pre-stroke functional status and to have a discussion about the risks and benefits. The committee believed that including people over 60 years would not necessarily lead to significantly more people undergoing surgery because informed discussion of the outcomes might reduce its uptake in this population. In addition, increasing the population eligible for endovascular therapy and its provision is likely to decrease the population referred for decompressive hemicraniectomy. The committee therefore did not anticipate a substantial resource impact to result from this recommendation. Return to recommendations 2022 Context Since NICE published its guideline on stroke and transient ischaemic attack (TIA) in 2008, the management of stroke has changed. New evidence has emerged in areas such as thrombectomy (clot retrieval procedures) in ischaemic stroke, controlling high blood pressure in people with acute haemorrhagic stroke, the role of hemicraniectomy and early mobilisation and optimum positioning of people with acute stroke. In addition, there is some uncertainty about the use of aspirin when TIA is first suspected, the role of conventional risk stratification in TIA and the best approach to intracerebral imaging after TIA. This guideline update includes recommendations on these specific issues. A stroke occurs when the blood supply to a part of the brain is acutely compromised. Most strokes (85%) are caused by a blockage in a blood vessel (artery) that supplies blood to the brain. A TIA or 'mini stroke' has the same clinical presentation as a stroke except that symptoms disappear within 24 hours. The symptoms experienced depend on the part of the brain that is affected. They usually occur suddenly and without any warning. 