Background <p>Proprotein Convertase Subtilisin/Kexin Type 9 inhibitors (PCSK9i) reduce low-density lipoprotein cholesterol (LDL-C), stabilize or even reverse atherosclerotic plaques, and decrease the incidence and recurrence of ischemic stroke. However, their role in the acute phase of ischemic stroke remains unclear. This study aimed to evaluate the effects of PCSK9i on neurological function, the inflammatory response, and lipid profiles in patients with acute ischemic stroke (AIS).</p> Method <p>A total of 180 patients with acute ischemic stroke who met the inclusion and exclusion criteria were enrolled from Baoding No.1 Central Hospital between January 2024 and July 2025. The patients were divided into an observation group (<i>n</i> = 80, treated with PCSK9i combined with standardized treatment) and a control group (<i>n</i> = 100, treated with standardized treatment).Inflammatory factors [interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP)], low-density lipoprotein cholesterol and National Institutes of Health Stroke Scale (NIHSS) scores were compared between the two groups on day 7 (± 1).This study was approved by the Ethics Committee of Baoding No.1 Central Hospital.</p> Results <p>After treatment, low-density lipoprotein cholesterol levels decreased in both groups, with the observation group showing a more significant reduction (<i>P</i> &lt; 0.05). The level of interleukin-6 in the observation group decreased, whereas that in the control group slightly increased compared with the level at admission (<i>P</i> &lt; 0.05). The National Institutes of Health Stroke Scale scores at discharge were lower than those at admission in both groups, with the observation group showing greater improvement (<i>P</i> &lt; 0.05).</p> Conclusion <p>PCSK9i can effectively reduce the levels of low-density lipoprotein cholesterol and interleukin-6 in patients with acute cerebral infarction and improve the National Institutes of Health Stroke Scale scores.</p> Clinical trial number <p>not applicable.</p>