{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:49:20Z","timestamp":1791510560758,"version":"4.3.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Intracranial atherosclerotic stenosis is a major cause of ischemic stroke with high recurrence rates despite intensive therapy. The efficacy of proprotein convertase subtilisin\/kexin type 9 inhibitors (PCSK9i) as adjunctive treatment in intracranial atherosclerotic stenosis remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a prospective, randomized, open\u2010label, blinded\u2010end point trial involving 62 patients with symptomatic intracranial atherosclerotic stenosis. Participants were randomized 1:2 to receive either a PCSK9i (alirocumab 75\u2009mg every 2\u2009weeks) plus high\u2010intensity statin or high\u2010intensity statin alone for 6\u2009months. The primary outcome was the change in intracranial artery stenosis measured by high\u2010resolution vessel\u2010wall magnetic resonance imaging. Secondary outcomes included plaque enhancement volume, low\u2010density lipoprotein cholesterol target achievement (&lt;55\u2009mg\/dL), recurrent stroke events, modified Rankin Scale, and safety assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 62 participants (median age, 66\u2009years; 77% men), 60 completed the study per protocol. At 6\u2009months, median stenosis reduction was greater in the PCSK9i group (7.1%; interquartile range, 3.6\u201312.8%) than in controls (\u22121.2%; interquartile range, \u22124.9\u20134.5%) (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). The baseline\u2010adjusted mean difference estimated using a generalized linear model was 8.9 percentage points (95% CI, 5.1\u201312.6). Both groups showed significant reduction in plaque enhancement volume, but between\u2010group difference was not significant (4.3 versus 4.0\u2009mm\n                      <jats:sup>3<\/jats:sup>\n                      ;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.79). Low\u2010density lipoprotein cholesterol &lt;55\u2009mg\/dL was achieved in 85% of the PCSK9i group versus 13% of controls (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.01). Recurrent stroke occurred in 5% versus 13% of patients (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.34). No serious adverse events were reported in either group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In patients with symptomatic intracranial atherosclerotic stenosis, adjunctive PCSK9i therapy significantly reduced intracranial stenosis and improved low\u2010density lipoprotein cholesterol control over 6\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique Identifier: NCT05001984.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.048729","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:53:02Z","timestamp":1788965582000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Add\u2010On PCSK9 Inhibitor Therapy for Acute Stroke Attributable to Intracranial Atherosclerosis: A Randomized Clinical Trial"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2485-4783","authenticated-orcid":false,"given":"Yi\u2010Ting","family":"Pan","sequence":"first","affiliation":[{"name":"Chang Gung Memorial Hospital at Chiayi, Chang\u2010Gung University College of Medicine","place":["Taoyuan City, 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