This article updates the European Stroke Initiative (ESI) Recommendations for Stroke Management, covering both ischemic stroke and transient ischemic attacks (TIAs) as a single entity. The guidelines address referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific acute management, complication management, and rehabilitation. Key recommendations include the importance of immediate EMS contact and priority dispatch, the organization of pre-hospital and in-hospital pathways, and the use of advanced imaging techniques such as cranial CT and MRI. The guidelines also emphasize the need for multidisciplinary care in stroke units and the implementation of telemedicine to expand access to high-technology specialist stroke care. Additionally, they provide detailed recommendations for diagnostic imaging, blood tests, and primary prevention strategies, including management of vascular risk factors such as hypertension, diabetes, hyperlipidemia, smoking, alcohol consumption, and physical activity.This article updates the European Stroke Initiative (ESI) Recommendations for Stroke Management, covering both ischemic stroke and transient ischemic attacks (TIAs) as a single entity. The guidelines address referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific acute management, complication management, and rehabilitation. Key recommendations include the importance of immediate EMS contact and priority dispatch, the organization of pre-hospital and in-hospital pathways, and the use of advanced imaging techniques such as cranial CT and MRI. The guidelines also emphasize the need for multidisciplinary care in stroke units and the implementation of telemedicine to expand access to high-technology specialist stroke care. Additionally, they provide detailed recommendations for diagnostic imaging, blood tests, and primary prevention strategies, including management of vascular risk factors such as hypertension, diabetes, hyperlipidemia, smoking, alcohol consumption, and physical activity.