From first responders to outcome modulators: The evolving paradigm of neutrophils in ischemic stroke and thrombolysis.

Neutrophils are increasingly recognized as pivotal contributors to the ischemic stroke cascade, influencing disease progression, thrombolysis outcomes, and patient prognosis. Epidemiological evidence consistently links neutrophil counts with the incidence of ischemic stroke. Pathophysiologically, neutrophils play critical roles in disrupting blood-brain barrier, amplifying inflammatory responses, and promoting thrombotic processes. Understanding their role is crucial for developing targeted therapies to improve stroke outcomes. This review focuses on the role of neutrophils in ischemic stroke, covering epidemiology, pathophysiological mechanisms, historical perspectives, interactions with rt-PA thrombolysis, clinical implications, controversies, challenges, and future directions.