Beyond anterior circulation: clinical outcomes of edaravone dexborneol in posterior circulation stroke

Edaravone dexborneol, a neuroprotective compound with dual antioxidant and anti-inflammatory properties, has been shown to improve recovery in acute ischemic stroke (AIS). Evidence regarding its use in patients with posterior circulation stroke has not been investigated. This study aims to evaluate the clinical effectiveness of edaravone dexborneol in this patient subgroup.

Patients with vertebrobasilar artery occlusion or stenosis (≥50%) were included from the Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke (EXPAND) study between December 2022 and October 2023.Patients were categorized into those treated with edaravone dexborneol (37.5 mg twice daily for 14 days) and those not receiving the drug. The primary endpoint was the distribution of the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included independent ambulation (mRS 0-3), functional independence (mRS 0-2), changes in National Institutes of Health Stroke Scale (NIHSS) scores and 90-day quality of life (EuroQol 5-Dimension 5-Level [EQ-5D-5L]). Safety outcomes were mortality within 90 days, adverse events (AE) and serious adverse events (SAE) during hospitalization . Analyses were adjusted for baseline covariates, with sensitivity analyses using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).

Among 256 patients (180 treated, 76 controls). At 90 days, a shift in the distribution of scores on the mRS toward better outcomes was observed in favor of (adjusted common OR, 1.69; 95%CI, 1.03-2.78; P=0.04). However, this benefit was not statistically significant in PSM (common OR, 1.65; 95% CI, 0.88-3.11; P=0.12) or IPTW analyses (common OR, 1.43; 95% CI, 0.89-2.31). Functional independence (OR, 1.64; 95% CI, 0.81-3.35) numerically favored edaravone dexborneol but did not reach statistical significance. Greater NIHSS improvement was also observed (adjusted β=-1.95; P=0.03), while functional independence, independent ambulation and EQ-5D-5L scores were similar between groups. There were no significant differences in mortality, AE and SAE between groups.

In this study, edaravone dexborneol demonstrated a potential signal for improved functional outcomes in the primary analysis, but sensitivity analyses did not confirm a definitive benefit. The results are exploratory and should be interpreted cautiously and require validation in adequately powered randomized controlled trials.