Factors Influencing Nerinetide Effect on Infarct Volume in Patients Without Alteplase in the Randomized ESCAPE-NA1...

Area of Science:

• Neuroscience
• Stroke Research
• Clinical Trials

Background:

• The ESCAPE-NA1 trial investigated nerinetide for acute ischemic stroke.
• A post hoc analysis focused on patients not receiving intravenous alteplase.
• This study assessed nerinetide's impact on final infarct volume and identified outcome predictors.

Purpose of the Study:

• To evaluate nerinetide's effect on final infarct volume in acute ischemic stroke patients without alteplase.
• To identify predictors of infarct volume and modifiers of nerinetide's treatment effect.

Main Methods:

• Secondary analysis of the ESCAPE-NA1 randomized trial data.
• Included 446 patients undergoing endovascular thrombectomy without intravenous alteplase.
• Final infarct volume was manually segmented; multivariable regression identified predictors and interactions.

Main Results:

• Nerinetide significantly reduced final infarct volume (β = -0.35).
• Predictors of smaller infarcts included hypertension history, good collateral filling, MCA occlusion, lower NIHSS, lower SBP, lower glucose, shorter time to randomization, and higher ASPECTS.
• Nerinetide attenuated negative effects of elevated systolic blood pressure, general anesthesia, and poor reperfusion.

Conclusions:

• Nerinetide treatment strongly correlated with smaller infarct volumes in patients not receiving alteplase.
• The infarct-reducing effect of nerinetide was greater in patients with poor prognostic factors.