Efficacy and Safety of Cerebrolysin as an Adjunct to Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

One of the primary causes of morbidity and death is still acute ischemic stroke (AIS). Although mechanical thrombectomy (MT) yields better results, problems such as partial functional recovery persist. By lessening secondary damage and encouraging recovery, the neuroprotective drug, cerebrolysin, may improve the effectiveness of MT. Its safety and efficacy as an adjunct to MT are assessed in this study. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until June 2025. A total of three studies were included after final screening. Outcomes were reported as symptomatic intracranial hemorrhage, adverse effects, mortality, etc. Interstudy heterogeneity was assessed using I2 and χ2 statistics (I2 > 50% = significant heterogeneity). Statistical calculations were performed using Review Manager 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark), with a p-value of < 0.05 indicating statistical significance. By combining data from three studies, this meta-analysis assessed the safety and effectiveness of cerebrolysin as a supplement to mechanical thrombectomy (MT) in acute stroke. This meta-analysis pooled data from three observational studies involving a total of 294 patients; 148 were treated with Cerebrolysin in combination with mechanical thrombectomy (Cerebrolysin + MT group), and 146 were treated with mechanical thrombectomy alone (MT group).With a very slight heterogeneity (I2 = 2%), Cerebrolysin significantly increased the primary outcome, Good Functional Outcome (mRS 0-3). Among 71 patients in the Cerebrolysin + MT group and 163 in the MT-alone group, a good functional outcome was achieved in 61 versus 110 patients, respectively (RR: 1.56, 95% CI: 1.25-1.93, p < 0.0001). There were sustained protective tendencies and a significant decrease in the incidence of symptomatic intracerebral hemorrhage (sICH) (RR: 0.12, 95% CI: 0.03-0.48, p = 0.03). sICH occurred in 4 of 148 patients in the Cerebrolysin group versus 9 of 148 in the control group. Benefits persisted at 1 and 12 months, with mortality being 64% lower in the Cerebrolysin group (RR: 0.36, 95% CI: 0.18-0.68, p = 0.02). Mortality was reported in 13 of 246 patients in the Cerebrolysin group versus 41 of 255 in the control group. Across outcomes, there was little heterogeneity. These results indicate cerebrolysin's potential as an adjuvant treatment for stroke management by indicating that it dramatically improves functional recovery, lowers sICH, and decreases mortality post-MT. Cerebrolysin shows promise as a useful neuroprotective treatment in stroke care by dramatically improving functional recovery, reducing symptomatic intracranial bleeding, and lowering mortality in acute ischemic stroke patients when used in conjunction with mechanical thrombectomy. Nonetheless, these conclusions are derived from only three observational studies with small sample sizes, which limits the robustness and generalizability of the findings. Further large-scale randomized trials are warranted to confirm these effects.