Neuroprotection in atherothrombotic stroke

Introduction. A cumulative meta-analysis of randomized multicentre placebo-controlled studies of ischemic stroke (IS) therapy confirmed benefit of citicoline treatment in terms of increase of chance for better recovery of functional independence. The effect was observed in cases when citicoline was used at the early stages of IS. To confirm international evidence for the domestic citicoline (Ceresil® Canon), the Research Centre of Neurology analysed its own clinical material on its use in patients with acute ischemic stroke.

Aim. To evaluate the efficacy of citicoline (Ceresil® Canon) in the acute phase of atherothrombotic stroke after systemic thrombolysis.

Materials and methods. The study group included 43 patients (27 men and 16 women, mean age 62 ± 11 years) with primary atherothrombotic stroke after systemic thrombolysis. Patients were randomly assigned to receive citicoline or standard therapy at 24 hours after recanalization. Randomization was conducted using a method with sealed envelopes. Patients (n = 24, mean age 59 ± 12 years; 17 men, 7 women; NIHSS score of 12 (9; 14) after systemic thrombolysis) received citicoline at a dose of 2,000 mg/day (solution for intravenous and intramuscular administration 250 mg/ml) IVFD for 10 days as part of standard therapy regimen, then citicoline at a dose of 1,000 mg/day (oral solution 100 mg/ml) for oral use for 45 days. The comparator group (standard therapy) included 19 patients with ischemic stroke (mean age 63 ± 12 years; 10 men, 9 women; NIHSS score of 11 (8; 13)), who underwent systemic thrombolysis, but did not receive citicoline.

Results. 70.8% of patients with atherothrombotic stroke who received citicoline added to their treatment regimen after systemic thrombolysis achieved a score of ≤2 on the modified Rankin Scale (mRS) (mild disability and functional independence) by day 56 of treatment. Patients who did not receive citicoline after systemic thrombolysis and achieved this score accounted for 36.8%. The differences between the groups were statistically significant (p = 0.034).

Conclusion. Prescription of citicoline to patients with atherothrombotic stroke after systemic thrombolysis at a dose of 2000 mg/day IVFD for 10 days, followed by oral use at a dose of 1000 mg (10 ml of solution) for oral use 45 days as part of standard therapy allows to achieve improvement of functional status.

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