Worldwide, acute ischemic stroke continues to be the primary cause of death and disability, requiring ongoing improvements in treatment approaches. With an emphasis on current advancements in collateral evaluation, thrombolytic therapy, endovascular thrombectomy, and neuroprotective treatment, this review examines novel treatments for acute ischemic stroke. To find relevant research published in the past five years, a thorough search of academic databases was carried out. The inclusion criteria for the inclusion of articles on innovative therapeutics and their implications for managing acute stroke were methodological rigor and direct relevance. With an emphasis on the effectiveness and safety of Tenecteplase, the review emphasizes the crucial role that collateral circulation plays in forecasting patient response to reperfusion treatments and the changing landscape of thrombolytic drugs. Furthermore, the treatment of acute strokes has been transformed by developments in endovascular thrombectomy, which provides better functional results for patients with major artery occlusions. Additionally, neuroprotective drugs have potential as complementary treatments, especially when used in combination with reperfusion procedures. Novel treatments for acute ischemic stroke provide fresh chances to improve patient outcomes and lower stroke-related morbidity and death. To provide equal access to improved stroke care, solve outstanding difficulties, and enhance treatment regimens, further research is required.