Acute Ischemic Stroke
Conditions
Keywords
PCSK9 inhibitor, Cohort study, Large-Artery Atherosclerotic, Functional outcome
Brief summary
This prospective multicenter cohort study aims to evaluate the effectiveness and safety of early PCSK9 inhibitor therapy in patients with large-artery atherosclerotic ischemic stroke. The study will compare early neurological improvement, lipid-lowering effect, 90-day functional outcome, recurrent cardio-cerebrovascular events, and safety outcomes between patients treated with evolocumab plus statin and those treated with statin alone.
Detailed description
This is a prospective, multicenter, consecutively enrolling cohort study to be conducted at the First Affiliated Hospital of Harbin Medical University and participating centers in Heilongjiang Province. Eligible patients are adults 18-80 years old with acute ischemic stroke of the large-artery atherosclerotic subtype (TOAST classification), LDL-C ≥1.8 mmol/L, and onset-to-enrollment time ≤72 hours. Participants will be assigned to exposure cohorts according to the actual lipid-lowering treatment initiated in routine clinical care. The exposed cohort will receive evolocumab 140 mg subcutaneously every 2 weeks or 420 mg monthly, plus daily statin therapy, for 90 days. The non-exposed cohort will receive daily statin therapy alone for 90 days. The planned total enrollment is 1000 participants, targeting approximately 500 participants per cohort. Visits and assessments will be performed at baseline, Day 7 (±2 days) or hospital discharge, Day 30 (±7 days), and Day 90 (±7 days) after stroke onset. The primary outcome is the proportion of participants with favorable functional outcome (mRS 0-2) at Day 90. Safety follow-up continues through Day 90 whenever feasible, even if evolocumab is discontinued.
Interventions
None listed
Sponsors
First Affiliated Hospital of Harbin Medical University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-80 years. 2. Acute ischemic stroke diagnosed according to the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke (2023), based on clinical and imaging criteria. 3. Large-artery atherosclerotic subtype (TOAST classification) confirmed within 72 hours after stroke onset. 4. NIHSS score 4-20 before treatment. 5. Pre-stroke modified Rankin Scale (mRS) score ≤1. 6. LDL-C ≥1.8 mmol/L before enrollment. 7. Able to use evolocumab and statin medications in accordance with the physician's instructions and the prescribing information. 8. No prior use of a PCSK9 inhibitor before enrollment. 9. Written informed consent provided by the participant or legally authorized representative.
Exclusion criteria
1. Hemorrhagic transformation or other intracranial hemorrhage (including hemorrhagic infarction, subarachnoid hemorrhage, subdural hematoma, or epidural hematoma), except cerebral microbleeds detected only by SWI. 2. Prior intracranial or extracranial endovascular therapy before enrollment, planned acute endovascular therapy within 90 days, or planned surgery that may affect outcome assessment. 3. Severe cardiac insufficiency：NYHA class III or IV. 4. Severe hepatic dysfunction (ALT or AST \>3 x upper limit of normal) or severe renal dysfunction (serum creatinine \>2 mg/dL, eGFR \<30 mL/min/1.73 m2, or requiring dialysis). 5. Platelet count \<100 x 10\^9/L. 6. Pregnancy or breastfeeding. 7. Participation in another interventional clinical study within 30 days before enrollment, or concurrent participation in another interventional study that may affect outcome assessment. 8. Giant intracranial tumor, giant cerebral aneurysm, or arteriovenous malformation. 9. Active gastrointestinal ulcer, active bleeding tendency: corrected international normalized ratio (INR) \> 1.5, bleeding time exceeding the upper limit by more than 1 minute, or increased bleeding risk due to heparin-induced thrombocytopenia; major systemic bleeding occurring within 30 days prior to enrollment. 10. Pre-existing neurologic or psychiatric disease likely to affect neurologic or functional outcome assessment; severe neurologic deficit causing loss of independent living; dementia or psychiatric disease preventing completion of follow-up. 11. Autoimmune disease (for example systemic sclerosis, systemic lupus erythematosus, Sjogren syndrome, Behcet disease, mixed connective tissue disease, or IgG4-related disease). 12. Active seizures, hypotension, hyperthyroidism, asthma, and other allergic respiratory diseases, as well as individuals with a tendency toward allergies. 13. Any other condition judged by the investigator to make participation inappropriate or to pose substantial risk.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of participants with favorable functional outcome at Day 90 | 90 ± 7 days after stroke onset | Proportion of participants with modified Rankin Scale (mRS) score 0-2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ordinal distribution of mRS at Day 90 | 90 ± 7 days after stroke onset | Distribution of mRS scores 0-6 at the 90-day follow-up assessment. |
| Incidence of early neurologic deterioration (END) and severe END | Within 7 days after enrollment | END: increase of ≥2 points in total NIHSS or ≥1 point in motor subscore within 7 days. Severe END: increase of ≥4 points in total NIHSS or ≥2 points in motor subscore within 7 days. |
| Change in NIHSS score from baseline | Up to Day 7 (±2 days) | Change in NIHSS score from baseline to Day 7 (±2 days) or hospital discharge, whichever comes first. |
| Change in LDL-C from baseline | 30 ± 7 days after stroke onset | Change in fasting LDL-C concentration from baseline to the Day 30 follow-up assessment. |
| Recurrent cardio-cerebrovascular events | Within 90 days after stroke onset | Incidence of recurrent ischemic stroke, myocardial infarction, or other adjudicated cardio-cerebrovascular events during follow-up. |
| All-cause mortality | Within 90 days after stroke onset | Death from any cause during follow-up |
Countries
China
Contacts
CONTACTZhongling Zhang
CONTACTShanshan Yang
PRINCIPAL_INVESTIGATORZhongling Zhang
First Affiliated Hospital, Harbin Medical University
Outcome results
None listed