Stroke Management: A Comprehensive, Evidence Based Review

Stroke is a leading cause of mortality and long term disability worldwide and represents a major public health challenge. Contemporary stroke management spans hyperacute reperfusion therapies, acute medical and neurosurgical care, structured stroke unit management, early multidisciplinary rehabilitation, and long term secondary prevention. Over the last three decades, high quality randomized controlled trials and guideline updates have transformed stroke care from predominantly supportive management to highly time sensitive, evidence driven interventions. The National Institute of Neurological Disorders and Stroke (NINDS) trial established intravenous alteplase within 3 hours as standard therapy for eligible ischemic stroke patients, while ECASS III extended benefit to the 3–4.5 hour window. In 2015, multiple landmark trials (MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, REVASCAT) demonstrated major functional benefit from mechanical thrombectomy in anterior circulation large vessel occlusion. Secondary prevention trials including PROGRESS, SPARCL, CHANCE, and POINT inform optimal blood pressure control, lipid lowering therapy, and antithrombotic strategies. This review synthesizes pivotal trials, international guideline recommendations, acute and long term management strategies, rehabilitation principles, and current controversies, with structured tables summarizing the evidence base to support clinical practice.