Early PCSK9 Inhibitor Use Correlates With Improved Outcomes in Patients With Acute Stroke Receiving Endovascular...

Area of Science:

• Cardiovascular Medicine
• Neurology
• Pharmacology

Background:

• Clinical benefits of early proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor use post-endovascular therapy (EVT) for acute large vessel occlusion (LVO) are not well-established.
• Investigating the association between early PCSK9 inhibitor administration and clinical outcomes in LVO patients undergoing EVT is crucial for optimizing stroke treatment.

Purpose of the Study:

• To determine if early administration of PCSK9 inhibitors following EVT in patients with acute LVO is associated with improved clinical outcomes.
• To evaluate the impact of PCSK9 inhibitors on early artery reocclusion and functional outcomes at 90 days post-EVT.

Main Methods:

• Retrospective cohort study of patients with acute LVO and successful EVT recanalization.
• Patients were grouped based on early administration (within 96 hours) of PCSK9 inhibitors (evolocumab or alirocumab).
• Propensity score matching was used to control for baseline differences; primary outcome was early artery reocclusion.

Main Results:

• Early PCSK9 inhibitor use was associated with a significantly lower incidence of early artery reocclusion (3.4% vs. 12.9%, OR 0.24).
• A greater proportion of patients receiving PCSK9 inhibitors achieved favorable 90-day functional outcomes (mRS 0-2: 77.6% vs. 60.3%, OR 2.28).
• Safety outcomes were comparable between groups; mediation analysis indicated reduced early artery reocclusion partially mediated the functional benefits.

Conclusions:

• Early PCSK9 inhibitor administration following EVT for acute LVO is linked to reduced early artery reocclusion.
• This strategy improves 90-day functional outcomes in LVO patients without increasing adverse events.
• Early PCSK9 inhibition represents a promising therapeutic approach to enhance recovery after EVT for acute ischemic stroke.