Abstract

Introduction

Stroke remains a leading cause of disability and mortality worldwide, necessitating the development of novel pharmacological interventions. Traditional treatments, including thrombolytics (e.g., alteplase) and antiplatelet agents, have demonstrated efficacy but are limited by time-dependent administration, risk of hemorrhage, and variable patient response. Recent advancements in neuroprotection, neurorepair, and targeted molecular therapies offer new avenues for stroke management. This review evaluates emerging drug candidates and their impact on clinical neurological development.

Methods

A systematic review was conducted using PubMed, Scopus, and clinical trial databases to identify studies published between 2015 and 2024. The inclusion criteria encompassed preclinical and clinical trials evaluating novel stroke therapeutics. The selected drugs were categorized based on their mechanisms of action, including neuroprotective agents, anti-inflammatory compounds, and regenerative therapies. Data extraction focused on efficacy, safety, and translational potential compared to standard treatments.

Results

Several promising agents have emerged in stroke therapeutics. Neuroprotective drugs such as NA-1 (nerinetide) have shown potential in reducing ischemic damage by inhibiting postsynaptic density protein-95 interactions, though clinical results remain mixed. Anti-inflammatory agents, including fingolimod and interleukin-1 receptor antagonists, have demonstrated improved outcomes by mitigating secondary brain injury. Regenerative therapies, such as stem cell-derived exosomes and granulocyte colony-stimulating factors, have exhibited neurorestorative effects in preclinical models. Novel thrombolytics like tenecteplase have demonstrated higher clot dissolution efficiency and a more favorable safety profile than alteplase, with extended therapeutic windows and reduced risk of intracranial hemorrhage.

Conclusions

Compared to standard treatments, novel stroke therapeutics offer significant advantages in efficacy and safety. While traditional thrombolytics such as alteplase remain the cornerstone of acute ischemic stroke treatment, newer agents like tenecteplase show superior fibrinolytic properties and extended treatment windows. Neuroprotective and anti-inflammatory drugs, though promising, have yet to surpass the clinical efficacy of reperfusion therapies but may provide adjunctive benefits. Regenerative strategies represent a paradigm shift, offering long-term functional recovery that conventional treatments lack. However, the full clinical translation of these novel drugs depends on large-scale trials validating their superiority over existing therapies. Future research should focus on personalized treatment approaches integrating pharmacogenomics and biomarker-based patient stratification to optimize stroke management.