Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis.

Safouris A; Katsanos AH; Kerasnoudis A; Krogias C; Kinsella JA; Sztajzel R; Lambadiari V; Deftereos S; Kargiotis O; Sharma VK; Demchuk AM; Saqqur M; McCabe DJH; Tsivgoulis G

doi:10.1161/STROKEAHA.118.021542

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Journal article

Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis.

Safouris A From the Second Department of Neurology (A.S., A.H.K., G.T.).
Katsanos AH From the Second Department of Neurology (A.S., A.H.K., G.T.).
Kerasnoudis A Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (A.K., C.K.).
Krogias C Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (A.K., C.K.).
Kinsella JA Department of Neurology, St Vincent's University Hospital, University College Dublin, Ireland (J.A.K.).
Sztajzel R Department of Neurology, University Hospital Geneva and Medical School, Switzerland (R.S.).
Lambadiari V Second Department of Internal Medicine (V.L.).
Deftereos S Second Department of Cardiology (S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
Kargiotis O Stroke Unit, Metropolitan Hospital, Piraeus, Greece (A.S., O.K.).
Sharma VK Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital (V.K.S.).
Demchuk AM Department of Clinical Neurosciences, University of Calgary, AB, Canada (A.M.D.).
Saqqur M Department of Neurology, University of Alberta, Edmonton, Canada (M.S.).
McCabe DJH Vascular Neurology Research Foundation, Department of Neurology and Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Ireland (D.J.H.M.).
Tsivgoulis G From the Second Department of Neurology (A.S., A.H.K., G.T.).

2018-07-12

Published in:

Stroke. - 2018

transcranial doppler sonography

Hydroxymethylglutaryl-CoA Reductase Inhibitors

English 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.

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