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Effect of Statin on Progression of Symptomatic Intracranial Atherosclerosis

Published online by Cambridge University Press:  02 December 2014

Hye-Jin Kim ,
Eun-Kyung Kim ,
Sun U. Kwon ,
Jong S. Kim  and
Dong-Wha Kang
Hye-Jin Kim
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Eun-Kyung Kim
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Sun U. Kwon
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Jong S. Kim
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Dong-Wha Kang*
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
*
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea. e-mail: dwkang@amc.seoul.kr
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Abstract

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Background:

Symptomatic intracranial atherosclerosis (ICAS) is a dynamic disease that frequently progresses. Statins have been shown to have anti-atherosclerotic activity. We therefore investigated whether statins could prevent progression of ICAS.

Methods:

This retrospective cohort study assessed 55 patients with acute ischemic stroke and symptomatic ICAS in the middle cerebral or basilar arteries as shown on magnetic resonance angiography (MRA), with follow-up MRA performed more than 1 year after the index stroke. Change in ICAS was classified as progressive, regressive, or stable. Baseline clinical characteristics and risk factor control during follow-up were assessed, and laboratory tests were performed at the time of follow-up MRA. The statin group was defined as patients regularly treated with statins for more than 75% of the follow-up period; the remaining patients were defined as the non-statin group.

Results:

At a median follow-up time of 21.8 months (range, 11.8-66.1 months), the statin group consisted of 26 (47.3%) patients and the non-statin group of 29 (52.7%). During follow-up, 6 (10.9%) patients progressed, 14 (25.5%) regressed, and 35 (63.6%) remained stable. Statin treatment was significantly associated with non-progression of ICAS (p=0.024). Two patients in the non-statin group had recurrent strokes. Border-zone infarcts were associated with progression of ICAS (3/6, 50%; p=0.007), whereas risk factors and inflammatory biomarkers were not related to progression.

Conclusions:

Treatment with statins may prevent progression of symptomatic ICAS. Prospective randomized controlled trials are required to confirm that statins protect against such progression.

Résumé

RÉSUMÉContexte:

L'athérosclérose intracrânienne (ASIC) symptomatique est une maladie dynamique souvent progressive. Il a été démontré que les statines ont une activité antiathéroscléreuse. Nous avons donc analysé si les statines pouvaient prévenir la progression de l'ASIC.

Méthode:

Il s'agit d'une étude rétrospective de cohorte de 55 patients atteints d'un accident vasculaire cérébral aigu (AVCA) et d'ASIC symptomatique de l'artère cérébrale moyenne ou du tronc basilaire démontrée par angiographie par résonance magnétique (ARM) avec reprise de l'ARM au moins 1 an après l'AVCA. Le changement au niveau de l'ASIC était classifié comme une ASIC ayant progressé, régressé ou qui était stable. Les caractéristiques cliniques initiales de base et la réduction des facteurs de risque au cours du suivi ont été évaluées. Des épreuves de laboratoire ont été effectuées au moment de l'ARM de contrôle. Les patients qui avaient pris une statine régulièrement pendant plus de 75% de la période de suivi étaient inclus dans le groupe statine. Les autres patients étaient inclus dans le groupe sans statine.

Résultats:

Le temps médian écoulé entre l'AVCA et l'examen de suivi était de 21,8 mois (écart 11,8 à 66,1 mois). Le groupe statine incluait 26 patients (47,3%) et le groupe sans statine 29 patients (52,7%). Au cours du suivi, une progression a été observée chez 6 patients (10,9%), une régression chez 14 patients (25,5%) et 35 patients (63,6%) sont demeurés stables. Le traitement par une statine était associé de façon significative à l'absence de progression de l'ASIC (p = 0,024). Deux patients du groupe sans statine ont subi d'autres AVC. Des infarctus dans la zone limite de l'AVC antérieur étaient associés à la progression de l'ASIC (3/6, 50%; p = 0,007) alors que les facteurs de risque et les biomarqueurs de l'inflammation n'étaient par reliés à la progression.

Conclusions:

Le traitement par les statines peut prévenir la progression de l'ASIC. Notre observation que les statines protègent contre la progression de l'ASIC devra être confirmée par des essais cliniques prospectifs randomisés et contrôlés par placebo.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 801 - 806
Copyright
Copyright © The Canadian Journal of Neurological 2012

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