<p>Aquaculture is widely recognized as a lever for food security, rural livelihoods, and sustainable economic development. Despite its abundant freshwater resources and ecological diversity, the Western Indian Himalayan Region contributes less than 0.5% of India’s total fish production—a disparity that reflects structural, institutional, and ecological constraints rather than resource scarcity. This review synthesizes current knowledge on aquaculture development across the WIHR and evaluates sustainability-related opportunities and challenges, drawing on peer-reviewed literature and government datasets. Following PRISMA 2020 guidelines, 80 studies were selected for qualitative synthesis from an initial pool of approximately 1000 records. Findings indicate that the region’s underperformance stems from a mutually reinforcing set of factors: heavy dependence on externally sourced fish seed (with transport mortality often exceeding 30%), slow adoption of technology, inadequate post-harvest infrastructure, and governance frameworks poorly adapted to mountain conditions. Environmental pressures—habitat fragmentation, invasive species proliferation, and microplastic contamination in high-altitude waterways—compound these structural weaknesses. The review identifies a pronounced disconnect between available resources and production outcomes, and proposes region-specific interventions including decentralized hatchery networks, modular Recirculating Aquaculture Systems, native broodstock conservation, solar-powered cold chains, and community-based value chains. Implemented with targeted policy support, these measures can position the WIHR as a model for sustainable cold-water aquaculture in mountain ecosystems globally.</p>