Abstract Number: Esoc2026a632 Cytoprotective Efficacy of Cerebrolysin in Patients With Residual Post-Thrombectomy Perfusion Deficits: A Proof-of-Concept Study

Background and aims Successful mechanical thrombectomy (EVT) does not always translate into functional independence, often due to residual hypoperfusion -“No Flow” phenomena. This proof-of-concept study investigated whether Cerebrolysin, in previous studies showing to promote neuroprotection and neuroplasticity, could improve outcomes in patients with less favorable post-EVT perfusion imaging profiles. Methods We prospectively evaluated 18 patients (N=18) who underwent EVT for large vessel occlusion and received IV Cerebrolysin post-procedure. Baseline demographics, vascular risk factors, and clinical severity (NIHSS) were recorded. Post-EVT CT Perfusion was performed to assess residual Ischemic Core (rCBF < 30%) and Hypoperfusion (Tmax > 6s). The primary outcome was functional recovery at follow-up (mRS) and neurological improvement (final NIHSS). Results Patients had a mean age of 69.8 (56% female) with a typical risk factor profile. Patients presented with a median admission NIHSS of 15 and Post-EVT imaging revealed a median residual hypoperfusion (Tmax > 6s) of 4.63 ml and a median ischemic core of 0.5 ml. Despite this "less favorable" perfusion profile a low final median NIHSS of 3.5 and functional independence (mRS <3) was achieved in 33.3% of patients. A strong correlation was observed between the post-EVT ischemic core and the final mRS (ρ= 0.80), and core volumes > 1 ml were found to be a robust predictor of poor functional outcomes (mRS >2). Conclusions This proof-of-concept study showed that Cerebrolysin may facilitate neurological recovery in patients with "high-risk" imaging category. These results suggest that Cerebrolysin may protect "at-risk" tissue within residual hypoperfused zones, potentially decoupling neurological recovery from unfavorable post-procedural perfusion parameters. Conflict of interest I have recieved a reaseach Grant from Everpharm