Abstract Number: Esoc2026lt69 Lt69 - Safety and Efficacy of Glenzocimab as an Adjunct Therapy to Mechanical Thrombectomy (Green): A Double-Blind, Multicentre, Randomised Controlled Trial

Abstract Background and aims Mechanical thrombectomy (MT) is the cornerstone of acute ischemic stroke (AIS) treatment due to large vessel occlusion, yet incomplete recanalization remains a significant challenge. The glycoprotein VI receptor plays a pivotal role in platelet-mediated thromboinflammation, contributing to secondary brain injury. Glenzocimab, a humanized anti-glycoprotein VI antibody fragment, has shown promise in reducing symptomatic intracranial hemorrhage (sICH) and mortality when used in combination with intravenous thrombolysis (IVT) in the ACTIMIS trial. The GREEN trial aimed to evaluate the efficacy of glenzocimab as an adjunct to MT in participants with AIS, providing further insights into its potential role in improving clinical outcomes. Methods GREEN was a randomized, double-blind, multicenter, placebo-controlled, trial conducted across eight stroke centers in France. Participants aged 18 years or older with disabling AIS (NIHSS ≥6) eligible for MT within 0–24 hours of symptom onset were enrolled. Participants were randomly assigned in a 1:1 ratio to receive either glenzocimab (1000 mg intravenous infusion) or placebo, stratified by age, use of IVT, and time to treatment. The primary endpoint was the distribution of modified Rankin Scale (mRS) scores at 90 days, analyzed using ordinal logistic regression. Results Between January 3, 2023, and July 23, 2024,102 participants were randomized, 50 were assigned to glenzocimab and 52 to placebo. The study was terminated after a pre-planned interim analysis. Conclusions The GREEN trial, evaluating glenzocimab as an adjunct therapy to MT in AIS participants with LVO of the anterior circulation, in the 0-24 hour’s time window, was terminated early. Conflict of interest