Which LVO Stroke Patients Benefit from Edaravone Dexborneol Before EVT?

Adjunctive edaravone dexborneol given before endovascular thrombectomy (EVT) improved 90-day functional independence only in patients with anterior circulation large vessel occlusion (LVO) stroke and clinical-radiological mismatch. The finding comes from a prespecified subgroup analysis of the TASTE-2 trial presented at the World Stroke Congress (WSC) 2026 in Seoul, South Korea.¹

Zhiyuan Feng presented the findings. The analysis used a continuous metric, the NIHSS-ASPECTS Index (NAI), to categorize mismatch. Investigators proposed the index as a way to identify the patients most likely to benefit from cytoprotection, which is intended to limit reperfusion injury after EVT.¹

In the overall TASTE-2 population, published in The BMJ, 55.0% of patients receiving edaravone dexborneol achieved functional independence at 90 days compared with 49.6% of placebo recipients (risk ratio [RR], 1.11; 95% CI, 1.00-1.23).² The new analysis sought to identify where within this population the treatment effect was concentrated.

Which Patients with LVO Stroke Benefited from Edaravone Dexborneol Before EVT?

TASTE-2 (NCT05249920) was a multicenter, randomized, placebo-controlled trial conducted at 106 centers in China. This secondary analysis included 1358 adults aged 18 to 80 years with anterior circulation LVO who were scheduled for EVT within 24 hours of onset. Participants received intravenous edaravone dexborneol or placebo before EVT, continued twice daily for 10 to 14 days.¹

The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0 to 2. Investigators used subpopulation treatment effect pattern plot (STEPP) analysis to empirically determine the optimal NAI cut-off for defining mismatch subgroups.¹

Among mismatch-positive patients, 58.1% of those treated with edaravone dexborneol achieved functional independence at 90 days versus 39.5% with placebo (RR, 1.47; 95% CI, 1.22-1.77; P < .001). The interaction between treatment and mismatch status was highly significant (P for interaction = .0002). In the mismatch-negative subgroup, functional independence rates were 53.2% with edaravone dexborneol and 55.5% with placebo, a difference without statistical significance (P = .50).¹

How is the NIHSS-ASPECTS Index Calculated, and What Threshold Defined Mismatch?

The NAI was calculated as the National Institutes of Health Stroke Scale (NIHSS) score divided by 11 minus the Alberta Stroke Program Early CT Score (ASPECTS). STEPP analysis set an NAI of 8 or higher as the threshold for mismatch-positive status, which applied to 510 patients. The remaining 848 patients, with an NAI below 8, were classified as mismatch negative.¹

Did Edaravone Dexborneol Reduce Early Neurological Deterioration?

Early neurological deterioration was also less frequent with edaravone dexborneol in the mismatch-positive group. It occurred in 8.0% of treated patients versus 14.3% of those receiving placebo (RR, 0.56; 95% CI, 0.33-0.94; P = .027).¹ The investigators concluded the benefit of adjunctive edaravone dexborneol in patients undergoing EVT was confined to those with baseline mismatch. They described the NAI as a practical, readily available tool for tailoring cytoprotective therapy to maximize functional recovery.¹

Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Feng Z. Efficacy and safety of edaravone dexborneol in large vessel occlusion stroke patients with clinical-radiological mismatch: a prespecified subgroup analysis of the TASTE-2 trial. Presented at: World Stroke Congress 2026; October 21-23, 2026; Seoul, Republic of Korea.

2. Wang Y, et al. Edaravone dexborneol before endovascular thrombectomy for acute ischaemic stroke (TASTE-2): randomised clinical trial. BMJ. 2026;392:e086850. doi:10.1136/bmj-2025-086850.