Abstract 142: Safety and Efficacy of PCSK9 inhibitor injection in Pathients immediately before mechanical thrombectomy

Abstract

Introduction Statins are lipid‐lowering agents and have beneficial effects in patients with acute ischemic stroke, including in the hyperacute period around mechanical thrombectomy.Evolucumab, a PCSK9 inhibitor, is a fast‐acting drug that lowers serum LDL with beneficial effects during chronic stroke period. During an hyperacute ischemic stroke, the brain can be vulnerable, especially around reperfusion therapy. However, the clinical effect of PCSK9 inhibitor injection around mechanical thrombectomy is still unknown. Here we showed the efficacy and safety of PCSK9 inhibitor injection immediately prior to mechanical thrombectomy for these patients. Methods The subjects were stroke patients who underwent mechanical thrombectomy at Inha University Hospital from April 2019 to March 2023. Clinical profiles between the evolucumab group and the non‐user group were analyzed. Results Of the 263 patients enrolled, 112 (42.6%) were male and the mean age was 69.1 years. Of these, 42 patients received a single dose of a PCSK9 inhibitor immediately prior to intervention and additional injections were not made due to insurance issues. Evolukumab injection was determined according to physician preference. There were no significant differences between the two groups in age, gender ratio, major risk factors, stroke etiology, or prior statin treatment. Evolucumab group had a higher stent recovery rate than the non‐user group (70.7 vs 53.4%, p = 0.04). However, there were no significant difference in TICI grade, or symptomatic hemorrhage. Compared with non‐user group, Evolucumab group had the lower NIHSS score on discharge (12.41 vs 8.83, p=0.03) and seemed to have the lower in‐hopital mortality(12.2 vs 2.4% p=0.06) Mean LDL‐C levels at admission and 3 months after stroke did not differ between the two groups. Cardiovascular and other adverse events within 3 months were similar in both groups. Conclusion Evolocumab added to conventional high‐intensity statin therapy was well tolerated and appeared to be associated with lower in‐hospital mortality and lower NIHSS scores at discharge without additional side effects. Further large randomized clinical trials might be needed to investigate the beneficial effects of PCSK9i during hyperacute stroke period.