Efficacy of evolocumab combined with butylphthalide in patients with non-cardioembolic acute ischemic stroke

HUANG Lin; WANG Zhaolu; DAI Guanqun

doi:10.3969/j.issn.1672-8157.2025.08.003

Abstract：Objective To explore the efficacy and safety of evolocumab combined with butylphthalide in the treat-ment of patients with non-cardioembolic acute ischemic stroke(AIS).Methods A total of 128 patients with non-cardioembolic AIS who were diagnosed and treated in the First Affiliated Hospital with Nanjing Medical University from September 2023 to December 2024 were prospectively selected.They were divided into the observation group and the control group using a simple randomization method,with 64 patients in each group.Patients in the control group received antiplatelet aggregation treatment with 100 mg aspirin,lipid-lowering treatment with 20 mg atorvastatin calcium,and intravenous infusion of butylphthalide.Pa-tients in the observation group were additionally given subcutaneous injection of evolocumab once every 2 weeks in addition to the control group.Both groups received treatment for 14 days.The clinical efficacy,neurological deficit,daily living activi-ties,levels of lipid metabolism-related indicators,and incidence of adverse reactions before and after treatment were compared between the two groups.Results After treatment,the total effective rate was higher in the observation group than that in the control group(93.75%(60/64)vs 81.25%(52/64))(χ²=4.571,P<0.05).The National Institutes of Health Stroke Scale score and modified Rankin Scale score in the observation group were significantly lower than those in the control group((8.34±1.27)vs(11.45±1.13),(1.81±0.45)vs(2.11±0.51))(t=14.636,2.830,both P<0.05).Additionally,the observation group exhibited lower levels of low-density lipoprotein cholesterol((3.52±0.31)mmol/L)and apolipoprotein B((51.45±15.56)mg/dL)compared to the control group((3.66±0.33)mmol/L,(62.78±14.49)mg/dL),while apolipoprotein A1 level((77.71±5.21)mg/dL)in the obser-vation group was higher than that in the control group((71.87±5.22)mg/dL)(t=2.474,4.263,6.335,all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(10.94%(7/64)vs 14.06%(9/64))(χ²=0.286,P>0.05).Conclusion Evolocumab combined with butylphthalide in the treatment of patients with non-cardioembolic AIS can effectively improve patients'neurological deficits,enhance their activities of daily living,regulate lipid levels efficiently,and ex-hibit good safety.