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Deepak Yadav: What 2025 Evidence Tells Us About Stroke Care
Deepak Yadav/LinkedIn
Feb 23, 2026, 13:02

Deepak Yadav: What 2025 Evidence Tells Us About Stroke Care

Deepak Yadav, Consultant and Assistant Professor of Neurology at Amrita Hospital, shared on LinkedIn:

”Stroke Care Just Changed: What 2025 Evidence Tells Us (And Why It Matters)

Stroke medicine is moving fast — and 2025 quietly rewrote several ‘assumed truths.’

The European Stroke Organisation (ESO) Annual Stroke Evidence Update 2025 synthesised the most practice-changing trials across acute care, prevention, rehab, cognition, and systems of care

Acute Ischemic Stroke: Less Is More

Endovascular thrombectomy (EVT)

NO routine benefit for MeVO strokes

Medical therapy (including IV thrombolysis when eligible) remains the backbone

Bigger is not always better intervention

Tenecteplase (TNK)

TNK before thrombectomy improves 90-day functional outcomes

Higher early recanalisation vs alteplase

TNK is now strongly reinforced as bridging therapy

Late-window thrombolysis (4.5–24 h)

Can help highly selected patients using advanced imaging
Tissue > time, but selection is everything

Intracerebral Haemorrhage (ICH): TIME equals BRAIN

Blood pressure control

Early, intensive BP lowering (<140 mmHg) is SAFE

Best outcomes when started within 3 hours. Delay here = lost recovery

Post-ICH prevention

Low-dose polypill strategy achieved SBP ≈127 mmHg

Reduced recurrent stroke without added harm

Simple combinations beat therapeutic inertia

Secondary Prevention: Old Dogmas Fall

Atrial fibrillation
Early DOAC initiation (≤4 days) ↓ recurrent stroke

Adding antiplatelet therapy? More bleeding, no benefit

ESUS
Anticoagulation still does NOT beat aspirin,  Precision is better than empiricism

Factor XIa inhibition (Asundexian)
Infrequent ischaemic stroke without more bleeding

Works in non-cardioembolic stroke / high-risk TIA

A glimpse of safer antithrombotic future

Cognition and Life After Stroke

Post-stroke dementia

Risk continues for YEARS

Metabolic syndrome equals major modifiable driver
Acute reperfusion- lower dementia risk by ~65%

What helps cognition?

  • Computerised cognitive training
  • Brain stimulation
  • Cardiorespiratory exercise

Stroke care does not equal discharge care

Systems of Care: Organisation saves Neurons

  • Mobile Stroke Units

Improve outcomes

Cost-effective in high-volume systems

  • Workflow optimisation

Behaviour-change packages – lower door-to-puncture time
Better 90-day outcomes

Process design is a treatment

What Everyone Should Know

  • EVT – not for all vessel occlusions
  • Tenecteplase is gaining ground
  • BP control after ICH is urgent, not optional
  • Early anticoagulation in AF is safer than we thought
  • Stroke recurrence risk remains high for years
  • Cognition and rehabilitation are not ‘extras’
  • Systems and workflows save as many lives as drugs

Final Thought

Stroke care is no longer about doing more — It’s about doing the right thing, faster, for the right patient.

Source: European Stroke Organisation – Annual Stroke Evidence Update 2025 (European Stroke Journal, 2026)”

Deepak Yadav: What 2025 Evidence Tells Us About Stroke Care

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