ABSTRACT NUMBER: ESOC2026A1610 THE EFFECT OF TRANSDERMAL GLYCERYL TRINITRATE ON EARLY NEUROLOGICAL DETERIORATION AND 90 DAY FUNCTIONAL AND COGNITIVE OUTCOMES IN PATIENTS WITH ACUTE LACUNAR SYNDROME STROKE

Abstract Background and aims Short-term transdermal glyceryl trinitrate (GTN) was associated with improved early neurological outcome, but did not influence functional and cognitive outcomes at 90 days, in patients with lacunar syndrome (LACS) stroke in the ENOS trial. We performed an individual patient data meta-analysis to assess the effect of GTN on early neurological deterioration (END), functional and cognitive outcomes in LACS patients. Methods We searched for completed randomised controlled trials of GTN vs. no GTN with data on stroke syndrome recruited within 48 hours of stroke onset. Stroke syndrome was assessed using the Oxfordshire Community Stroke Project classification. END was defined as neurological deterioration by day 7. Functional status was assessed using the modified Rankin Scale (mRS) at day 90. Cognitive and functional outcomes were amalgamated to create ordinal 4- and 7-level scales. Meta-analysis of individual patient data used logistic regression adjusted for trial and prognostic variables. Results Four trials met inclusion criteria. Of 1650 participants with LACS, 821 (49.8%) received GTN and 829 (50.2%) no GTN. END did not differ between GTN vs. no GTN: 33 (4.0%) vs. 27 (3.3%). There was no difference in the mRS at day 90 between GTN vs. no GTN: OR 1.04, 95% CI 0.87-1.24, p=0.66. Similarly, GTN did not influence the 4- or 7-level cognitive scales at day 90: 4-level OR 0.95, 95% CI 0.73-1.25, p=0.73; 7-level OR 0.96, 95% CI 0.75-1.24, p=0.76. Conclusions Short-term transdermal GTN did not influence END and day 90 functional and cognitive outcomes in acute LACS patients. Conflict of interest Appleton JP: nothing to disclose; Woodhouse LJ: nothing to disclose; Wardlaw JM: nothing to disclose; Bath PM: nothing to disclose