Evaluation of Neuroprotective Agents In Acute Ischemic Stroke Patients Undergoing Endovascular Treatment: A Systematic Review and Meta-analysis
Hafiz Talha Javed1, Muhammad Hassan Akhtar2, Sama Almasri1, Ali Hamdan2, Esha Tanveer2, Abeeha Kaleem2, Nabiha Kashif2, Fatima Hamid2, Muhammad Abdullah Yasin2, Muhammad Qasim Qureshi2, Huda Afzal3, Divya Nayar1, Saba Sattar2
1Department of Neurology, University of Arkansas for Medical Sciences, 2Department of Neurology, King Edward Medical University, 3Department of Neurology, Punjab Medical College
Objective:
We evaluated the functional, cognitive, and safety profiles of neuroprotective agents such as Edaravone-Dexborneol, uric acid, and NXY-059 compared to standard treatment in Acute Ischemic Stroke(AIS) patients undergoing endovascular treatment.
Background:
Neuroprotective agents have long been investigated as adjunctive therapies in AIS and have shown promising biological effects in preclinical studies, but their aggregate impact on patient-centered outcomes remains unclear.
Design/Methods:
We searched PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials(RCTs) fulfilling the inclusion criterion. The primary endpoint was favorable 90-day functional outcome(mRS ≤1). Secondary outcomes included changes in NIHSS, Barthel Index(BI), cognitive scores, mortality, and adverse events(AE). Pooled effect estimates were calculated using random-effects models in R, expressed as odds ratios(OR) for binary outcomes and mean differences(MD) for continuous outcomes, with 95% confidence intervals(CI). Heterogeneity was assessed with I2 statistic.
Results:
Nine RCTs (n=7,903; mean age 67.7 years; 58.9% male) were included. Compared to controls, neuroprotectants were associated with higher odds of achieving favorable functional outcomes (mRS ≤1) at 90 days (OR = 1.22; 95% CI: 1.04–1.43) but with higher rates of infusion-related (OR 1.48; 95% CI 1.19–1.86) and treatment-related (OR 1.34; 95% CI 1.12–1.60) adverse events. Although severe AE leading to withdrawal were less frequent (OR 0.72; 95% CI 0.56–0.91) in the treatment group. A small and statistically insignificant improvement was observed in both NIHSS at 14 days (MD –0.21; 95% CI –0.50 to 0.08) and BI. Cognitive outcome by Montreal Cognitive Assessment Score (MoCA) and mortality were not significantly different.
Conclusions:
Pooled clinical data in AIS patients receiving endovascular treatment reveal that use of neuroprotective agents has a modest functional benefit but a consistent safety signal for increased treatment-related adverse events. These findings challenge the role of currently available neuroprotectants in AIS and underscore the need for future trials targeting patient subgroups, optimizing dosing strategies, and prioritizing long-term functional recovery.
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