Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis.

Abstract

OBJECTIVE:

Although statin pretreatment (SP) is associated with better outcomes in patients with acute cerebral ischemia after an ischemic stroke/transient ischemic attack, data on the underlying mechanism of this beneficial effect are limited.

APPROACH AND RESULTS:

We sought to evaluate the potential association between SP and microembolic signal (MES) burden in acute cerebral ischemia because of large artery atherosclerosis (LAA). We prospectively evaluated consecutive patients with first-ever acute cerebral ischemia because of LAA in 3 tertiary stroke centers over a 2-year period. All patients underwent continuous 1-hour transcranial Doppler monitoring of the relevant vessel at baseline (≤24 hours). SP was recorded and dichotomized as high dose or low-to-moderate dose. SP was documented in 43 (41%) of 106 LAA patients (mean age, 65.4±10.3 years; 72% men; low-to-moderate dose, 32%; high dose, 8%). There was a significant (P=0.022) dose-dependent effect between SP and MES prevalence: no SP (37%), SP with low-to-moderate dose (18%), and SP with high dose (0%). Similarly, a significant (P=0.045) dose-dependent effect was documented between SP and MES burden: no SP (1.1±1.8), SP with low-to-moderate dose (0.7±1.6), and SP with high dose (0±0). In multivariable logistic regression analysis adjusting for demographics, vascular risk factors, location of LAA, stroke severity, and other prevention therapies, SP was associated with lower likelihood of MES presence (odds ratio, 0.29; 95% confidence interval, 0.09-0.92; P=0.036). In addition, SP was found also to be independently related to higher odds of functional improvement (common odds ratio, 3.33; 95% confidence interval, 1.07-10.0; P=0.037).

CONCLUSIONS:

We found that SP in patients with acute LAA is related with reduced MES presence and lower MES burden with an apparently dose-dependent association.

• Authors: Apostolos Safouris, Christos Krogias, Vijay K Sharma, Aristeidis H Katsanos, Simon Faissner, Andromachi Roussopoulou, Christina Zompola, Janina Kneiphof, Odysseas Kargiotis, Spyridon Deftereos, Georgios Giannopoulos, Nikos Triantafyllou, Konstantinos Voumvourakis, Konstantinos Vadikolias, Georgios Tsivgoulis
• Journal: Arteriosclerosis, thrombosis, and vascular biology (Arterioscler Thromb Vasc Biol) Vol. 37 Issue 7 Pg. 1415-1422 (07 2017) ISSN: 1524-4636 [Electronic] United States
• PMID: 28450295 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2017 American Heart Association, Inc.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Brain Ischemia (diagnostic imaging, epidemiology, prevention & control)
• Cerebral Angiography (methods)
• Chi-Square Distribution
• Computed Tomography Angiography
• Dose-Response Relationship, Drug
• Female
• Germany (epidemiology)
• Greece (epidemiology)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Intracranial Arteriosclerosis (diagnostic imaging, drug therapy, epidemiology)
• Intracranial Embolism (diagnostic imaging, epidemiology, prevention & control)
• Ischemic Attack, Transient (diagnostic imaging, epidemiology, prevention & control)
• Logistic Models
• Magnetic Resonance Angiography
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Prevalence
• Prospective Studies
• Risk Factors
• Singapore (epidemiology)
• Tertiary Care Centers
• Time Factors
• Treatment Outcome
• Ultrasonography, Doppler, Transcranial