Abstract Body: INTRODUCTION
Clinical guidelines have become an essential tool for updating medical professionals. Its use in clinical practice reduces the possibility of medical harm and promotes appropriate medical practices. However, the publication of guidelines in vascular neurology is often inconsistent between medical entities, making access and interpretation of recommendations difficult.

METHODS
Systematic review of guidelines published by the American, Brazilian, and European Academies of Neurology (AAN, ABN, and EAN), and societies endorsed by such academies (American Heart Association/American Stroke Association – AHA/ASA, European Stroke Organization – ESO), from 2012 to 2023 in the area of vascular neurology, selected through the official websites of the respective institutions. Evaluated the number and proportion of recommendations made.

RESULTS
A total of 61 guidelines were analyzed: 5 published by ABN, 34 by EAN/ESO, and 22 by AAN/AHA/ASA. There were 2,547 recommendations, with 261 published by ABN (10,24%), 548 published by EAN/ESO (21,51%) and 1,738 (68,23%) published by AAN/AHA/ASA. There were 430 recommendations with LOE A (16.88%), 1,003 with LOE B (39.37%), and 785 with LOE C (30.82%). Only EAN/ESO adopted the GRADE system in 31 of its 34 publications, with 20 recommendations rated as high (0.78%), 68 as moderate (2.66%), 95 as low (3.72%), and 145 as very low (5.69%). There were 242 recommendations with level of evidence A/Class I (IA), with 178 (73.55%) published by AAN/AHA/ASA. Recommendations classified as high quality of evidence and strong strength of recommendation (high/strong) totaled 17, all published by EAN/ESO. There have been 27 guidelines published in the last 4 years (2020-2023), which were responsible for 709 recommendations (27,83%). The average number of recommendations per guideline in this period was lower when compared to previous years – 26,25 recommendations per guideline versus 54,05.

CONCLUSION
Less than 20% of recommendations in vascular neurology in current guidelines are classified as level A of evidence (LOE A), and less than 1% of the total recommendations receive a high-quality classification in articles that used the GRADE system. New approaches to conducting clinical research are needed to enable the generation of high-quality evidence in a more pragmatic and efficient way.