Abstract 164: Evaluation of Neuroprotective Agents In Acute Ischemic Stroke Patients Undergoing Endovascular Treatment: A Systematic Review and Meta‐analysis

Introduction Neuroprotective agents have long been investigated as adjunctive therapies in acute ischemic stroke (AIS), yet clinical translation has been elusive. Agents such as Edaravone‐Dexborneol, uric acid, and NXY‐059 have shown promising biological effects in preclinical studies, but their aggregate impact on patient‐centered outcomes remains unclear. This meta‐analysis evaluates the functional, cognitive, and safety profiles of these agents compared to standard treatment in AIS patients undergoing endovascular treatment. Methods We systematically searched PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) of Edaravone‐Dexborneol, uric acid, or NXY‐059 in AIS patients undergoing endovascular treatment. The primary endpoint was a 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 the I‐squared statistic, and sensitivity analyses were performed. 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 measured 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. In conclusion, 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. image