Effect of statin on progression of symptomatic basilar artery stenosis and subsequent ischemic stroke

Abstract

Background and objectiveSymptomatic basilar artery stenosis (BAS) is associated with high risk of ischemic stroke recurrence. We aimed to investigate whether statin therapy might prevent the progression of symptomatic BAS and stroke recurrence.MethodsWe retrospectively analyzed the data of patients with acute ischemia with symptomatic BAS, which was assessed using magnetic resonance angiogram (MRA) imaging on admission day, and 1 year later (or the day of the clinical event). The clinical endpoints were recurrent ischemic stroke and its composites, transient ischemic attack, coronary disease, and vascular death.ResultsOf the 153 patients with symptomatic BAS, 114 (74.5%) were treated with a statin after experiencing a stroke. Statin therapy significantly prevented the progression of symptomatic BAS (7.0% vs 28.2%) and induced regression (22.8% vs 15.4%) compared to non-statin users (p = 0.002). There were 31 ischemic stroke incidences and 38 composite vascular events. Statin users showed significantly lower stroke recurrence (14.9% vs 35.9%, p = 0.05) and composite vascular events (17.5% vs 46.2%; odds ratio [OR], 0.29; 95% confidence interval [CI], 0.13–0.64) than those not using statins did. Recurrent stroke in the basilar territory and composite vascular events were more common in patients with progression of BAS than they were in other patients (OR, 5.16; 95% CI, 1.63–16.25 vs OR, 4.2; 95% CI, 1.56–11.34).ConclusionOur study suggests that statin therapy may prevent the progression of symptomatic BAS and decrease the risk of subsequent ischemic stroke. Large randomized trials are needed to confirm this result.

Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting

“…Medical therapy, such as statins and antihypertensives, should be considered for the long-term secondary prevention of stroke. In a retrospective study of 153 patients with symptomatic BA stenosis, Yum et al [8] reported a much lower stroke recurrence of 14.9% for patients taking statins, compared to 35.9% in those that did not. They also reported progression of the BA stenosis in 7.0% of patients in the statin group compared to 28.2% in the non-statin group.…”

The prevention of stroke by statins: A meta-analysis

“…Finally, 9 studies that met the criteria were contained in this meta-analysis. [13][14][15][16][17][18][19][20][21] As shown in Table 1, a total of 9 RCTs and 15,497 study subjects (prevention group [n = 4114], control group [n = 11383]) were contained in this meta-analysis. The included eligible studies were published from 2002 to 2019, and the locations of studies were mainly in Asia, America, and Europe.…”