NOVEL APPROACHES IN STROKE PREVENTION AND TREATMENT IN CONTEMPORARY NEUROLOGY

Abstract

Stroke remains a leading cause of mortality and long-term disability worldwide, prompting continuous evolution of preventive and therapeutic strategies. This comprehensive scientific review synthesizes breakthrough developments in stroke care published between 2025 and early 2026, focusing on innovative approaches in prevention, acute management, and emerging therapeutics. In secondary prevention, novel oral anticoagulants have demonstrated clear superiority over warfarin in atrial fibrillation-related ischemic stroke, with significant reductions in stroke or systemic embolism, all-cause mortality, and hemorrhagic complications including intracranial bleeding. Contemporary acute ischemic stroke management has shifted toward precision-based, time-sensitive paradigms incorporating mobile stroke units, tissue-clock neuroimaging, and artificial intelligence–assisted decision support. Tenecteplase has emerged as a practical, non-inferior alternative to alteplase in large vessel occlusion, offering pharmacokinetic advantages and comparable safety profiles. Adjunctive therapies including tirofiban combined with thrombolysis significantly improve functional outcomes without increasing symptomatic intracranial hemorrhage risk. Early lipid-lowering with PCSK9 inhibitors in large artery atherosclerosis prevents early neurological deterioration and improves 90-day functional independence. Precision antithrombotic management now recognizes the long-term hemorrhagic risks of combining antiplatelet agents with anticoagulation. Translational nanomedicine advances demonstrate targeted neuroprotection using multifunctional selenium nanoparticles in experimental cerebral ischemia. This review concludes that contemporary stroke neurology is characterized by integration of advanced neuroimaging, pharmacological innovation, individualized antithrombotic strategies, and emerging neurorestorative paradigms.