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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Acute ischemic stroke treatment often involves thrombolysis.
  • Cerebral infarct size is a key determinant of patient outcomes.
  • Investigating adjunct therapies to improve thrombolysis efficacy is crucial.

Purpose of the Study:

  • To evaluate the efficacy of intravenous cyclosporine combined with thrombolysis in reducing cerebral infarct volume.
  • To assess the impact of cyclosporine on infarct size in anterior-circulation stroke patients.

Main Methods:

  • A multicenter, single-blinded, controlled trial involving 127 patients aged 18-85 with anterior-circulation stroke.
  • Patients received either intravenous cyclosporine (2.0 mg/kg) or placebo 15 minutes after randomization.
  • Primary endpoint: infarct volume on MRI at 30 days; secondary endpoints included infarct location and recanalization status.

Main Results:

  • Overall, cyclosporine did not significantly reduce infarct volume compared to placebo (21.8 mL vs. 28.8 mL, p=0.18).
  • A significant reduction in infarct volume was observed in patients with proximal arterial occlusion and effective recanalization (14.9 mL vs. 48.3 mL, p=0.009).
  • Class I evidence indicates no significant decrease in 30-day MRI infarct volume with thrombolysis plus IV cyclosporine versus thrombolysis alone.

Conclusions:

  • Intravenous cyclosporine is generally not effective in reducing cerebral infarct size in acute anterior-circulation stroke.
  • A subgroup analysis revealed a potential benefit in patients with proximal occlusion and successful recanalization.