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Updated: Jan 3, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
What Proportion of Patients Admitted with Stroke or Transient Ischemic Attack May Be Suitable for Newer
Vafa Alakbarzade1, Anthony C Pereira2
1Royal Cornwall Hospitals NHS Trust; Department of Neurology, Truro, United Kingdom.
Insights
Up to 13% of acute ischemic stroke or TIA patients may benefit from PCSK9 inhibitors. This study identified eligible patients for intensive cholesterol treatment, guiding future clinical trial sample sizes.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are effective in lowering LDL-C and non-HDL-C.
- Assessing the eligibility of stroke patients for advanced cholesterol-lowering therapies is crucial.
Purpose of the Study:
- To evaluate the proportion of acute stroke admissions eligible for PCSK9 inhibitor therapy.
- To inform sample size calculations for future clinical trials investigating PCSK9 inhibitors in stroke patients.
Main Methods:
- Retrospective analysis of 650 hyperacute stroke unit admissions over 5 months in 2017.
- Screening patients based on European guidelines for dyslipidemia management and PCSK9 inhibitor eligibility criteria.
- Excluding patients with hemorrhage, mimic syndromes, or incomplete lipid testing.
Main Results:
- Out of 324 acute ischemic stroke/TIA patients, 41 (13%) met criteria for PCSK9 inhibitors.
- Eligible patients had LDL-C ≥1.8mmol/L on maximal statin therapy and "very high vascular risk".
- Eighty-three percent of eligible patients also had non-HDL-C ≥2.6 mmol/L.
Conclusions:
- A significant minority of acute ischemic stroke/TIA patients are candidates for PCSK9 inhibitors.
- These findings provide valuable data for designing future clinical trials on PCSK9 inhibitors in stroke populations.
Background:
Protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors effectively clear low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). We evaluated stroke admissions potentially eligible for more intensive cholesterol treatment.
Methods:
Retrospective analysis of consecutive admissions to a hyperacute stroke unit over 5 months in 2017. Records were individually searched. Data were collected on diagnosis, risk factors, and stroke work-up. European Society of Cardiology and European Atherosclerosis Society guidelines for the management of dyslipidaemias were used for screening patients eligible for PCSK9 inhibitors.
Results:
Of 650 patient admissions: 351 (54%) had acute ischemic stroke or transient ischemic attack (TIA), 80 (12%) hemorrhage, and 219 (34%) mimic syndromes. Patients with hemorrhage (n = 80), mimic syndromes (n = 219), and absent LDL-C, or non-HDL-C testing (n = 27) were subsequently excluded. 324 patients with acute ischemic stroke and TIA were further screened for PCSK9-inhibitor treatment eligibility. Forty-one (13%) patients with LDL-C greater than or equal to 1.8mmol/L (≥70 mg/dL) on maximal tolerated statin dose and with concomitant "very high vascular risk" were identified. "Very high vascular risk" was defined as a documented history of cardiovascular disease and/or peripheral arterial disease. Of 41 patients eligible for PCSK9 inhibitors, median age was 82 years (range 53-96); median vascular risk factors were 2 (range 1-5); 7 (17%) had TIA; 13 (31%) had history of preceding cerebrovascular events, 13 (31%) diabetes mellitus, 17 (42%) cardioembolic events, 9 (22%) lacunar syndrome, 11 (22%) symptomatic internal carotid artery stenosis (n = 9 were >70%), and 4 (10%) undetermined aetiology. Eighty-three percent patients eligible for PCSK9 inhibitors also had non-HDL-C values greater than or equal to 2.6 mmol/L.
Conclusions:
Up to 13% of unselected acute ischemic stroke or TIA patients admitted to a hyper-acute stroke unit were potentially suitable for more intensive cholesterol treatment. Our data may act as a useful guide for sample size selection in future stroke trials testing PCSK9 inhibitors.
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