The writing group was asked to review the entire guideline, in- cluding the deleted recommendations. In June 2018, the writing group submitted a document with minor changes and with inclu- sion of important newly published randomized controlled trials (RCTs) with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent out to 14 peer reviewers. The writing group evaluated the peer reviewers comments and revised when appropriate. This revised document was reviewed by Stroke Council s Scientific Statements Oversight Committee and theAHA ScienceAdvisory and Coordinating Committee. To allow these guidelines to be as timely as possible, RCTs address- ing AIS published between November 2018 and April 2019 were reviewed by the writing group. Modifications of Section Table 1. Applying ACC/AHA Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015) Section 3.7.2., Recommendation 2 resulted. To allow these modi- fications to be incorporated, the standard peer review process was abbreviated, with review provided by the members of the Stroke Council s Scientific Statements Oversight Committee and by liaisons from the endorsing organizations listed on the masthead. The list of these reviewers is provided at the end of the guideline. The final document was approved by theAHA ScienceAdvisory and Coordinating Committee and Executive Committee. These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. They will not be applicable to all patients. Local resources and expertise, specific clinical circumstances and patient preferences, and evidence published since the issuance of these guidelines are some of the additional factors that should be considered when making individual patient care decisions. 