The following is a summary of “Infarct Evolution on MR-DWI After Thrombectomy in Acute Stroke Patients Randomized to Nerinetide or Placebo,” published in the December 2023 issue of Neurology by Fladt et al.

Primate studies suggest nerinetide, a neuroprotectant, could minimize brain damage after stroke. Researchers conducted a retrospective study to investigate if early infarct growth after stroke clot removal (measurable with MRI) predicts neuroprotective drug effectiveness and can be influenced by nerinetide.

They conducted REPERFUSE-NA1, an MRI substudy of the ESCAPE-NA1 randomized controlled trial involving patients with acute disabling large vessel occlusive stroke undergoing EVT within 12 hours of onset. Patients randomized to receive intravenous nerinetide or placebo underwent sequential MRI <5 hours post-EVT (day 1) and at 24 hours (day 2). The primary outcome was early total diffusion-weighted MRI infarct growth after EVT, defined as the lesion volume difference between day 2 and day 1. Region-specific stroke damage growth (measured by MRI) was analyzed for treatment differences with nerinetide.

The results showed that 67 of 71 patients had MRIs of sufficient quality. Median post-EVT infarct volume was 12.98 mL (IQR, 5.93–28.08) in the nerinetide group and 10.80 mL (IQR, 3.11–24.45) in the control group (P=0.59). Nerinetide recipients exhibited a median early secondary infarct growth of 5.92 mL (IQR, 1.09–21.30) compared with 10.80 mL (IQR, 2.54–21.81) in placebo patients (P=0.30). Intravenous alteplase modified nerinetide’s effect on region-specific infarct growth in white matter and basal ganglia compartments. In patients without alteplase, nerinetide reduced the infarct growth rate by 120% (SE, 60%) in the white matter (P=0.03) and by 340% (SE, 140%) in the basal ganglia (P=0.02) compared with placebo after adjusting for confounders.

They concluded that MRI tracks early stroke damage, hinting at nerinetide’s potential for white matter and basal ganglia protection, though the overall impact needs further study.

Source: neurology.org/doi/10.1212/WNL.0000000000207976