BENEFITS AND SAFETY OF PCSK9 INHIBITOR INJECTION IN PATHIENTSIMMEDIATELY BEFORE MECHANICAL THROMBECTOMY

초록

Background and aims: Evolucumab is a PCSK9 inhibitor(PCSK9i) and a fast-acting lipid lowering agent with beneficial effects during chronic stroke period. However, the clinical effect of PCSK9 inhibitor injection around mechanical thrombectomy(MT) is still unclear. Here we showed the efficacy and safety of PCSK9i injection immediate before MT. Methods: All subjects underwent MT 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 PCSK9i immediately prior to MT. 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). Cardiovascular and other adverse events within 3 months were similar in both groups. Conclusions: Evolocumab added to 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.