ABSTRACT NUMBER: ESOC2026A562 CEREBROLYSIN AFTER ENDOVASCULAR THROMBECTOMY IN STROKE: 12-MONTH FUNCTIONAL OUTCOMES IN A PROPENSITY-MATCHED COHORT

Abstract Background and aims Long-term outcomes after endovascular thrombectomy (EVT) and the incremental value of adjunct neuroprotective therapy remain uncertain. We performed a hypothesis-generating target-trial emulation to assess 12-month outcomes after adjunct Cerebrolysin. Methods Consecutive eligible EVT patients received Cerebrolysin 30 mL/day intravenously for 21 days starting immediately post-EVT, with a second 21-day course at days 69–90. Outcomes were compared with historical EVT-only controls using 1:1 nearest-neighbor propensity score matching on prespecified covariates. The primary endpoint was 12-month functional independence (modified Rankin Scale [mRS] 0–2). Secondary endpoints included 12-month ordinal mRS shift, Barthel Index (BI), and institutional care; the safety endpoint was all-cause mortality. Associations were estimated using multivariable logistic regression and proportional-odds ordinal models, with prespecified sensitivity analyses including adjustment for calendar time. Results Fifty patients per group were analyzed. Cerebrolysin was associated with higher odds of 12-month functional independence (aOR 6.10, 95%CI 1.6–22.6; p<0.01) and a favorable shift across the 12-month mRS distribution (common OR 3.57, 1.4–8.9; p<0.01), with directionally consistent results after calendar-time adjustment. Twelve-month mortality was 18% in both groups. Among survivors, institutional care was required in 6% of the Cerebrolysin group vs 19% of controls (unadjusted OR 0.26, 0.07–0.99). BI was higher with Cerebrolysin (median [Q1–Q3] 92 [82–100] vs 83 [73–93]; p=0.01). Conclusions In highly selected EVT patients, adjunct Cerebrolysin was associated with better 12-month functional outcomes; however, residual confounding cannot be excluded. Randomized trials are needed to establish efficacy and define optimal use. Conflict of interest Jacek Staszewski: Nothing to disclose Aleksander Dębiec: nothing to disclose; Katarzyna Gniadek-Olejniczak: nothing to disclose; Piotr Piasecki: nothing to disclose