Stroke is the leading cause of death in China, with over 2 million new cases annually. The burden is expected to increase due to population aging, high prevalence of risk factors (e.g., hypertension), and inadequate management. Despite improved access to services, specialist stroke care varies across the country, especially in rural areas. In-hospital outcomes have improved with greater availability of reperfusion therapies and supportive care, but adherence to secondary prevention and long-term care remains inadequate. Thrombolysis and stroke units are standard of care, but concerns over bleeding risk and organizational challenges hinder widespread adoption. Chinese herbal products and neuroprotective agents are widely used despite limited evidence, while over-diagnosis and over-treatment of 'silent stroke' due to increased neuroimaging use are issues. Future efforts should focus on providing balanced stroke services, enhancing evidence-based practice, and encouraging translational research.Stroke is the leading cause of death in China, with over 2 million new cases annually. The burden is expected to increase due to population aging, high prevalence of risk factors (e.g., hypertension), and inadequate management. Despite improved access to services, specialist stroke care varies across the country, especially in rural areas. In-hospital outcomes have improved with greater availability of reperfusion therapies and supportive care, but adherence to secondary prevention and long-term care remains inadequate. Thrombolysis and stroke units are standard of care, but concerns over bleeding risk and organizational challenges hinder widespread adoption. Chinese herbal products and neuroprotective agents are widely used despite limited evidence, while over-diagnosis and over-treatment of 'silent stroke' due to increased neuroimaging use are issues. Future efforts should focus on providing balanced stroke services, enhancing evidence-based practice, and encouraging translational research.