Effects of PCSK9 inhibitor evolocumab on preventing early neurological deterioration in acute ischemic stroke patients with or without large artery atherosclerosis: a subgroup analysis of a randomized trial

Your competent? doctor WORKED UP AN EXACT PROTOCOL TO PREVENT EARLY NEUROLOGICAL DETERIORATION A LONG TIME AGO, RIGHT? NO? So, your doctor, hospital and board of directors are completely fucking incompetent? Thus, making damn sure you'll never get to 100% recovery!

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING?

Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name(If you can't stand by your name don't bother replying anonymously) and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you aren't working on 100% recovery protocols with NO EXCUSES!

Early neurological deterioration (26 posts to January 2017)

pcsk9 (10 posts to November 2012)

Effects of PCSK9 inhibitor evolocumab on preventing early neurological deterioration in acute ischemic stroke patients with or without large artery atherosclerosis: a subgroup analysis of a randomized trial

• Jiahui Liu, 
• Ying Li, 
• Wen Tian, 
• Hua Cao, 
• Xidan Li, 
• Liyuan Cheng, 
• Xiaofei Ji & 
• Jing Liu 

BMC Neurology volume 25, Article number: 431 (2025) Cite this article

Abstract

Background

Our previous study has demonstrated the preventive effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on early neurological deterioration (END) in patients with acute non-cardiogenic ischemic stroke. Here, we performed a post hoc subgroup analysis to investigate whether the large artery atherosclerosis (LAA) subtype contributed to the clinical outcomes.

Methods

According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, patients were divided into LAA and small vessel occlusion (SVO) subgroups. In each subgroup, patients were further subdivided into combination therapy of evolocumab and atorvastatin (PI group) and atorvastatin monotherapy (AT group). The primary outcome was END within 7 days, defined as a ≥ 2-point National Institutes of Health Stroke Scale (NIHSS) score increase or NIHSS motor score ≥ 1-point compared with baseline.

Results

A total of 272 patients were included: 186 were categorized into the LAA subtype (93 in the PI group and 93 in the AT group) and 86 into the SVO subtype (43 in the PI group and 43 in the AT group). Compared with AT group, the primary analyses showed a significantly lower incidence of END with PI group in the LAA subtype (14.0% versus 28.0%; RR, 0.45; 95% CI, 0.26 to 0.80; p = 0.006), but not in the SVO subtype (11.6% versus 16.3%; RR, 0.77; 95% CI, 0.26 to 2.33; p = 0.649). Similar results were observed in terms of favorable functional Outcome at 90 days, combination therapy of evolocumab and atorvastatin was significantly associated with a high proportion of modified Rankin Scale scores of 0–2 at 90 days in the LAA group (81.7% versus 61.3%; RR, 1.39; 95% CI, 1.18 to 1.65; p < 0.001), but not in the SVO subtype (86.0% versus 74.4%; RR, 1.16; 95% CI, 0.95 to 1.42; p = 0.157). Other outcomes were similar between the two treatment groups in patients with LAA or SVO subtypes.

Conclusions

Among patients with LAA subtype stroke, combination therapy of evolocumab and atorvastatin may be superior to atorvastatin monotherapy regarding preventing END.

Trial registration

http://www.chictr.org.cn. Identifier: ChicTR2200059445. Date of registration: 29 April 2022.