Recent Advances in Pharmacotherapy for Acute Ischemic Stroke: Emerging Neuroprotective and Regenerative Agents—A Comprehensive Narrative Review

Binai k Sankar; Fathima Shafna Karunakarth; Nithin kinattukaraparambil; Al Febina Nivas

Recent Advances in Pharmacotherapy for Acute Ischemic Stroke: Emerging Neuroprotective and Regenerative Agents—A Comprehensive Narrative Review

Author(s)	Prof. Binai k Sankar, Ms. Fathima Shafna Karunakarth, Mr. Nithin kinattukaraparambil, Ms. Al Febina Nivas
Country	India
Abstract	Background: One of the leading causes of death worldwide and long-term neurological impairment is acute ischemic stroke (AIS). Although intravenous thrombolysis and endovascular thrombectomy are reperfusion methods that are considered the standard of care, a significant number of patients are left without adequate treatment due to their limited therapeutic windows and eligibility restrictions. With a focus on neuroprotective and neuroregenerative agents such as sovateltide, edaravone, dexborneol, butylphthalide, nerinetide, tenecteplase, stem cell-based therapies, and remote ischemic conditioning, this review summarizes the most recent research on new pharmacotherapeutic approaches for AIS. Methods: PubMed/MEDLINE, Scopus, and PubMed Central databases were used to conduct an organized narrative review. Randomized controlled trials and Phase II/III studies were given priority, and only Scopus-indexed, publicly accessible original publications and clinical trials published between 2020 and 2025 were chosen. Results: Sovateltide, an ETB receptor agonist, has been approved by Indian regulators after showing notable improvements in mRS and NIHSS at 90 days in Phase III trials. In comparison to a placebo, edaravone dexborneol (TASTE-SL study) considerably improved 90-day functional outcomes. At 90 days, butylphthalide (BAST trial) demonstrated greater functional independence. Tenecteplase showed logistical advantages and non-inferiority to alteplase. With encouraging preclinical findings, stem cell and exosome-based treatments are in the early phases of clinical development. Conclusion: AIS's developing pharmacotherapeutic landscape is encouraging. Neuroregenerative biologics, combination approaches, and multi-target therapies may be able to get around the drawbacks of existing monotherapy. To definitively prove clinical utility, more extensive, global, randomized controlled trials are necessary.
Keywords	Stroke; Acute Ischemic Stroke; Neuroprotection; Sovateltide; Emerging Therapies; Neuroregeneration; Pharmacotherapy; Clinical Outcomes
Field	Medical / Pharmacy
Published In	Volume 8, Issue 4, July-August 2026
Published On	2026-08-01

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Recent Advances in Pharmacotherapy for Acute Ischemic Stroke: Emerging Neuroprotective and Regenerative Agents—A Comprehensive Narrative Review

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