The recommendation on thrombectomy together with thrombolysis within 6 hours of symptom onset is aligned with current best practice and the NHS England clinical commissioning policy on mechanical thrombectomy for acute ischaemic stroke. The recommendation for thrombectomy between 6 and 24 hours requires a change from current practice by most providers. Currently, the NHS England clinical commissioning policy states that mechanical thrombectomy will be commissioned when substantial salvageable brain tissue is identified up to 12 hours. However, this extension of the eligibility period up to 24 hours was supported by clinical- and cost-effectiveness evidence as discussed above. The recommendation to consider endovascular therapy for posterior circulation stroke reflects current best practice. Overall, the new recommendations are likely to have a substantial resource impact on the NHS. Thrombectomy is already performed in most neuroscience centres, but the recommendations will mean 24-hour access to appropriate staffing and imaging. 2022 The committee discussed the possibility that the new recommendations could initially result in a large increase in referrals to centres that already have thrombectomy services. It also noted that there are likely to be additional costs incurred in transferring people to these centres. This will have implications for the spoke site for arranging transfers, for the ambulance service and at the hub site, where more people will be received. There may need to be networked arrangements for spoke sites around a thrombectomy 'hub' with fast image transfer, referral, eligibility assessment and responsive repatriation systems. The positive implications for other aspects of stroke care help to address the balance in demand for resources. For example, it is expected that there will be a decrease in demand for decompressive hemicraniectomies and inpatient rehabilitation. There may also be a reduction in the need for long-term social care. 