Stroke: intensive statin therapy effectively stabilises intracranial atherosclerotic plaque

Takeaway

• In patients with acute ischaemic stroke (AIS) and intracranial atherosclerotic disease (ICAD), high-dose statin therapy effectively stabilises symptomatic intracranial atherosclerotic plaques on serial high-resolution magnetic resonance imaging (HR-MRI) at 6 months.

Why this matters

• Pre-stroke statin use has been reported to modify plaque enhancement in symptomatic intracranial atherosclerosis.
• However, limited evidence exists over the long-term effects of high-dose statin treatment on the stabilisation of vulnerable intracranial plaques.

Study design

• The Intensive Statin Treatment in Acute Ischaemic Stroke Patients with Intracranial Atherosclerosis – HR-MRI (STAMINA-MRI), a single arm observational study included 77 patients with AIS and ICAD on high dose statin therapy.
• Primary outcomes: changes in stenosis degree, remodelling and wall area index and enhancement volume of atherosclerotic plaque on HR-MRI before and after 6 months of statin therapy.
• Funding: Samsung Medical Center and Dong-A Pharma, Inc. Seoul, South Korea.

Key results

• After 6 months of follow-up, high-dose statin therapy significantly reduced:
  • total cholesterol (123.20±24.53 mg/dL; P<.001),
  • triglyceride (121.85±53.28 mg/dL; P=.003),
  • low-density lipoprotein cholesterol (LDL-C; 60.95±19.28 mg/dL; P<.001),
  • non-high-density lipoprotein cholesterol (73.7±21.0 mg/dL; P<.001), and
  • apolipoprotein B (63.73±16.73; P<.001).
• After 6 months, statin therapy significantly reduced the wall area index (5.86±4.04; P=.016), stenosis degree (64.05±1.29%; P<.001) and enhancement volume of atherosclerotic plaque (17.06±4.53 mm³; P=.013) but not the remodelling index (P=.195).
• 35% of patients showed no change or increase in enhancement volume and stenosis degree after statin therapy.
• Higher reduction of LDL-C level and longer duration of therapy were associated with a reduction in enhancement volume after statin therapy.

Limitations

• Single-centre study with a small sample size.
• Significant variation in the time interval between initial and follow-up HR-MRIs.