Nerinetide Reduces Early Infarct Growth Among Stroke Patients Undergoing EVT Without Intravenous Alteplase

Area of Science:

• Neurology
• Radiology
• Pharmacology

Background:

• Nerinetide demonstrated improved clinical outcomes in acute ischemic stroke patients undergoing endovascular treatment without concurrent alteplase in the ESCAPE-NA1 trial.
• Alteplase administration inactivated nerinetide, negating its therapeutic effect in patients receiving both treatments.
• Hypothesis: Improved outcomes in no-alteplase patients correlate with reduced infarct growth.

Purpose of the Study:

• To investigate the effect of nerinetide on infarct growth in acute ischemic stroke patients undergoing endovascular treatment.
• To compare infarct growth between nerinetide and placebo groups in patients treated with and without alteplase.

Main Methods:

• Analysis of data from the no-alteplase stratum of the ESCAPE-NA1 trial.
• Utilized computed tomography perfusion (CTP) imaging to assess baseline infarct core and 24-hour infarct volume.
• Calculated infarct growth as the difference between 24-hour infarct volume and baseline infarct core.

Main Results:

• Prior alteplase administration significantly modified nerinetide's effect on infarct growth (P=0.005).
• In patients not receiving alteplase, nerinetide treatment was associated with significantly reduced infarct growth (19.6 mL) compared to placebo (34.9 mL; P=0.008).
• No significant difference in infarct growth was observed between nerinetide and placebo groups in patients who received prior alteplase (P=0.62).

Conclusions:

• Nerinetide significantly decreased infarct growth in acute ischemic stroke patients undergoing thrombectomy when not co-administered with alteplase.
• The findings support the hypothesis that reduced infarct growth is a radiological correlate of improved stroke outcomes with nerinetide in specific patient populations.