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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Sodium-Glucose Cotransporter 2 Inhibitors: An Emerging Therapeutic Approach for Ischemic Stroke Management
Yiwei Huang1, Xinyuan Yu1, Changxin Li2
1Department of Neurology, Shanxi Medical University, Jiefangnan 85 Road, Taiyuan, 030001, Shanxi, China.
CNS Drugs
|September 25, 2025
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) show promise for ischemic stroke (IS) management. Preclinical and observational studies suggest SGLT2i reduce stroke risk and infarct size, particularly in type 2 diabetes mellitus patients.
Area of Science:
- Neuroscience
- Endocrinology
- Cardiology
Background:
- Type 2 diabetes mellitus (T2DM) is a major risk factor for ischemic stroke (IS).
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are established therapies for T2DM and heart failure.
- Emerging evidence suggests SGLT2i may offer neuroprotection against IS.
Purpose of the Study:
- To systematically review and synthesize current evidence on the neuroprotective role of SGLT2i in ischemic stroke.
- To explore the preclinical and clinical data supporting SGLT2i for IS management.
- To elucidate the mechanisms underlying the potential neuroprotective effects of SGLT2i.
Main Methods:
- Systematic review of preclinical studies in animal models.
- Analysis of large-scale real-world observational clinical studies.
- Critical appraisal of existing evidence, including strengths and limitations.
Main Results:
- Preclinical studies consistently show reduced infarct volume and improved outcomes with SGLT2i.
- Observational studies indicate a significant reduction in stroke risk, especially in high-risk T2DM populations.
- Potential neuroprotective mechanisms include glucose-dependent pathways and glucose-independent effects like ketosis and reduced neuroinflammation.
Conclusions:
- SGLT2i demonstrate significant potential for ischemic stroke risk reduction and neuroprotection.
- Evidence is robust but largely observational; dedicated randomized trials are needed.
- Future research should focus on confirming efficacy in stroke-specific trials and addressing clinical challenges.
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