Association Between Stroke Subtype and Outcomes of Edaravone Dexborneol: A Subgroup Analysis of the EXPAND (Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke) Study

Background The effectiveness of edaravone dexborneol among acute ischemic stroke subtypes remains unclear. We evaluated its association with clinical outcomes by stroke subtype. Methods This secondary analysis of the prospective EXPAND (Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke) study included patients with acute ischemic stroke treated at 72 Chinese stroke centers from December 2022 to October 2023. Patients were classified as having large artery atherosclerosis (LAA) or non‐LAA stroke and grouped by edaravone dexborneol use. Primary outcomes were 90‐day modified Rankin Scale (mRS) scores of 0 or 1 and 0 to 2 and ordinal mRS shift. Safety outcomes were 90‐day mortality, intracranial hemorrhage, and in‐hospital adverse events. Results Among 4401 patients, 1061 (24.1%) had LAA and 3340 (75.9%) had non‐LAA stroke; the median age was 65 years, and 66.8% were men. Edaravone dexborneol was associated with improved 90‐day functional outcomes in the non‐LAA group, including higher odds of achieving mRS 0 or 1 (adjusted odds ratio [aOR], 1.25 [95% CI, 1.06–1.47]), mRS 0 to 2 (aOR, 1.40 [95% CI, 1.15–1.71]), and a favorable mRS shift (aOR, 1.28 [95% CI, 1.12–1.46]; all P <0.05). No significant functional benefit was observed in the LAA group of mRS 0 or 1 (aOR, 0.91; P =0.50), mRS 0 to 2 (aOR, 0.88; P =0.43), or mRS shift (aOR, 0.92; P =0.50). Significant interactions were observed between edaravone dexborneol and stroke subtype ( P for interaction=0.03 for mRS 0 or 1, P =0.005 for mRS 0 to 2, and P =0.009 for favorable mRS shift). Safety outcomes were comparable between treatment groups. Conclusions Edaravone dexborneol was associated with improved 90‐day functional outcomes in non‐LAA but not LAA stroke.