Contemporary Advances in Acute Stroke Management: A FullyIntegrated Review: Contemporary Advances in Acute Stroke Management
Authors
Sunetra D Phulsunge, Rakesh Singh, Rishikesh Joshi, Samantha KumarFiles
Key Information
Journal
Published in Vol. 68 No. 1 (2026) of Bombay Hospital Journal.
Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership.
Editor-in-Chief- Dr Satish Vasant Khadilkar
About the JournalAbstract
Background:
Acute stroke care has evolved in a substantial manner over the past three decades. Advances
in imaging-guided reperfusion, expansion of mechanical thrombectomy indications,
refinement of thrombolytic agents, and structured post-reperfusion and in-hospital care have
contributed to improved outcomes in both ischemic as well as hemorrhagic stroke.
Objective:
To bring together contemporary developments in acute ischemic stroke (AIS) and
intracerebral hemorrhage (ICH) and to integrate global evidence with practical considerations
relevant to Indian clinical settings.
Methods:
Narrative review of landmark trials from 1995-2026, major guideline updates with emphasis
on applicability to routine clinical practice.
Results:
Stroke therapeutics have progressed from early intravenous alteplase within narrow time
windows (2,3) to late-window reperfusion enabled by tissue-based imaging (4-6).
Tenecteplase has emerged as a practical alternative to alteplase due to ease of administration
and growing evidence supporting its safety and efficacy (15,16). Mechanical thrombectomy
now benefits patients across early and late windows (18,24,25), including those with large-
core infarction (12-14) and posterior-circulation stroke (26,27). Post-reperfusion
care—including blood pressure optimisation, neurological monitoring, and prevention of
secondary complications—plays a critical role in determining outcomes (31). ICH
management has advanced with emphasis on controlled blood pressure reduction (45,46),
targeted anticoagulation reversal (53-55), and minimally invasive surgical approaches (50-
52).
Conclusion:
Modern stroke care integrates tissue-based reperfusion strategies, evidence-based
antithrombotic therapy, and structured supportive care. Adaptation to Indian health-care
systems remains essential for equitable implementation. Timely intervention remains
essential to prevent irreversible brain injury.
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