Kim Jonguk, Hong Uichan, Yoon Cindy W, Bae Jin Woo, Rha Joung-Ho, Park Hee-Kwon
Department of Neurology, Inha University Hospital, Incheon, Republic of Korea.
Department of Neurosurgery, Inha University Hospital, Incheon, Republic of Korea.
Front Neurol. 2024 May 16;15:1375609. doi: 10.3389/fneur.2024.1375609. eCollection 2024.
Lipid-lowering therapies are mainstays in reducing recurrence after acute ischemic stroke (AIS). Evolocumab, a Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, is a promising lipid-lowering agent known to decrease LDL cholesterol and mitigate vascular events alongside statins. However, its effects on the early functional outcomes post-mechanical thrombectomy (MT) remain unclear. This study aimed to assess the short-term effects and incidence of bleeding events after the early, off-label use of PCSK9 inhibitors in AIS patients undergoing MT.
We retrospectively analyzed patients who had MT at a Regional Stroke Center from December 2018 to April 2023. Our primary outcome was discharge functional outcomes. Secondary outcomes included early neurologic deterioration (END), symptomatic intracerebral hemorrhage (sICH), 3-month functional outcomes, 3-month recurrence rate, and lipid profiles.
Of 261 patients (mean age 69.2 ± 11.7, men 42.9%), 42 were administered evolocumab peri-procedurally. While baseline characteristics were similar between the two groups, evolocumab group demonstrated improved discharge outcomes, with a lower mean NIHSS (8.8 ± 6.8 vs. 12.4 ± 9.8, = 0.02) and a higher percentage of patients with discharge mRS ≤ 3 (52.4% vs. 35.6%, = 0.041). The 3-month follow-up show a non-significant trend toward an improved outcome in the evolocumab group. Multivariable analysis indicated that evolocumab had a potential impact on favorable discharge outcomes (aOR 1.98[0.94-4.22] for mRS ≤ 3 and 0.47[0.27-0.84] for lower ordinal mRS). Notably, evolocuamb users exhibited fewer instances of END and sICH, although they do not reach statistical significance. Additionally, the evolocumab group demonstrated potential benefits in LDL cholesterol reduction over time.
Early use of evolocumab in AIS patients undergoing MT appeared to be safe and associated with better early functional outcomes. The potential benefit of the PCSK9 inhibitor shown here warrants further prospective studies.
降脂治疗是降低急性缺血性卒中（AIS）后复发率的主要手段。依洛尤单抗是一种前蛋白转化酶枯草溶菌素9型（PCSK9）抑制剂，是一种很有前景的降脂药物，已知它可降低低密度脂蛋白胆固醇，并与他汀类药物一起减轻血管事件。然而，其对机械取栓（MT）后早期功能结局的影响仍不清楚。本研究旨在评估在接受MT的AIS患者中早期非标签使用PCSK9抑制剂后的短期效果和出血事件发生率。
我们回顾性分析了2018年12月至2023年4月在一家地区性卒中中心接受MT的患者。我们的主要结局是出院时的功能结局。次要结局包括早期神经功能恶化（END）、症状性脑出血（sICH）、3个月时的功能结局、3个月时的复发率和血脂谱。
在261例患者（平均年龄69.2±11.7岁，男性占42.9%）中，42例在围手术期使用了依洛尤单抗。虽然两组的基线特征相似，但依洛尤单抗组的出院结局有所改善，平均美国国立卫生研究院卒中量表（NIHSS）评分较低（8.8±6.8 vs. 12.4±9.8，P = 0.），出院时改良Rankin量表（mRS）≤3的患者百分比更高（52.4% vs. 35.6%，P = 0.041）。3个月随访显示依洛尤单抗组有改善结局的非显著趋势。多变量分析表明，依洛尤单抗对良好的出院结局有潜在影响（mRS≤3时调整后比值比[aOR]为1.98[0.94 - 4.22]，较低序数mRS时为0.47[0.27 - 0.84]）。值得注意的是，使用依洛尤单抗的患者END和sICH的发生率较低，尽管未达到统计学显著性。此外，随着时间的推移，依洛尤单抗组在降低低密度脂蛋白胆固醇方面显示出潜在益处。
在接受MT的AIS患者中早期使用依洛尤单抗似乎是安全的，且与更好的早期功能结局相关。此处显示的PCSK9抑制剂的潜在益处值得进一步进行前瞻性研究。
