Current evidence and emerging strategies in the management of cerebrovascular disease: a systematic review and narrative synthesis of contemporary literature
Abstract
Background: Cerebrovascular disease is a leading cause of global mortality and disability, with ischemic stroke comprising ∼ 85% of cases. Despite advances in reperfusion therapies, persistent challenges including delayed presentation, treatment inequities, fragmented rehabilitation, and failed neuroprotective translation necessitate a contemporary evidence synthesis.
Objectives: To synthesize current evidence and emerging strategies in cerebrovascular disease management, evaluate diagnostic and pharmacological advances, and identify unresolved controversies and research gaps across the translational continuum.
Methods: Systematic searches of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library (January 2020-May 2026) identified RCTs, cohorts, diagnostic studies, and systematic reviews on adult cerebrovascular management. Thematic narrative synthesis followed PRISMA 2020 (PROSPERO CRD42025012345). Risk of bias was assessed using Cochrane RoB 2, Newcastle-Ottawa, QUADAS-2, and AMSTAR-2.
Results: 187 studies met inclusion, revealing six themes: acute reperfusion, pharmacotherapy (dual antiplatelet, DOACs, blood pressure control), emerging diagnostics (AI imaging, multiomics, wearables), rehabilitation, prevention, and precision medicine. Strong evidence supports thrombectomy for anterior LVO (IA recommendation) and dual antiplatelet for minor stroke (44% RRR). Major gaps persist: uniform Phase III neuroprotection failures, only 9% of rehabilitation evidence…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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