Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis.

Abstract

Background and Purpose- Scarce data indicate that statin pretreatment (SP) in patients with acute cerebral ischemia because of large artery atherosclerosis may be related to lower risk of recurrent stroke because of a decreased incidence of microembolic signals (MES) during transcranial Doppler monitoring. Methods- We performed a systematic review and meta-analysis of available observational studies reporting MES presence/absence or MES burden, categorized according to SP status, in patients with acute cerebral ischemia because of symptomatic (≥50%) large artery atherosclerosis. In studies with partially-published data, authors were contacted for previously unpublished information. We also performed a sensitivity analysis of studies with data on MES burden categorized according to SP status, and an additional subgroup analysis in patients receiving higher-dose SP (atorvastatin 80 mg or rosuvastatin 40 mg daily). Results- Seven eligible study protocols were identified (610 patients, 54% with SP). SP was associated with a reduced risk of MES detection during transcranial Doppler monitoring (risk ratio=0.67; 95% CI, 0.45-0.98), with substantial heterogeneity between studies ( I2=52%). In studies reporting MES burden (n=4), a significantly lower number of MES were identified in patients with compared with those without SP (mean difference=-0.92; 95% CI, -1.64 to -0.19), with no evidence of heterogeneity between studies ( I2=49%). Subgroup analysis revealed that higher-dose SP reduced the risk of detecting MES (risk ratio=0.23; 95% CI, 0.06-0.88), with no evidence of heterogeneity between studies ( I2=0%). Conclusions- SP seems to be associated with a lower incidence and burden of MES in patients with acute cerebral ischemia because of large artery atherosclerosis.

• Authors: Apostolos Safouris, Aristeidis H Katsanos, Antonios Kerasnoudis, Christos Krogias, Justin A Kinsella, Roman Sztajzel, Vaia Lambadiari, Spyridon Deftereos, Odysseas Kargiotis, Vijay K Sharma, Andrew M Demchuk, Maher Saqqur, Dominick J H McCabe, Georgios Tsivgoulis
• Journal: Stroke (Stroke) Vol. 49 Issue 8 Pg. 1992-1995 (08 2018) ISSN: 1524-4628 [Electronic] United States
• PMID: 29991656 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Brain Ischemia (diagnostic imaging, drug therapy)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage)
• Intracranial Arteriosclerosis (diagnostic imaging, drug therapy)
• Intracranial Embolism (diagnostic imaging, drug therapy)
• Microvessels (diagnostic imaging, drug effects)