Nanotechnology for ischemic stroke treatment: addressing challenges across stroke management stages

Ischemic stroke is a leading cause of mortality and long-term disability, with single acute interventions such as thrombolysis and mechanical thrombectomy limited by narrow therapeutic windows, hemorrhage risks, and challenges in crossing the blood-brain barrier (BBB). This review focuses on targeted therapeutic strategies across the four key stages of ischemic stroke management: prevention, neuroprotection, revascularization, and adjunctive therapy. By systematically analyzing each stage of ischemic stroke, we emphasize the necessity of staged intervention and the essential role of nanomedicines during each stage. From controlled drug release in the prevention stage to the extension of therapeutic time windows for acute intervention and to enhancing adjunctive outcomes in later stages, nanomedicines provide solutions to optimize treatment efficacy and minimize side effects. Finally, we provide perspectives on spatiotemporal control in nanomedicine for precision stroke treatment, including blood pressure and infarct temperature regulation, the crosstalk between systems, and gene therapy. This review underscores the transformative role of nanomedicines in ischemic stroke treatment and the potential to revolutionize stroke management by overcoming current clinical barriers and improving patient outcomes.