Preexisting Statin Use Is Associated With Greater Reperfusion in Hyperacute Ischemic Stroke

Abstract

Background and Purpose Statin pretreatment has been associated with improved outcomes in patients with ischemic stroke. Although several mechanisms have been examined in animal models, few have been examined in patients. We hypothesized that patients using statins before stroke onset may have greater reperfusion than patients not using statins. Methods Acute ischemic stroke patients underwent two MR scans: within 4.5 (tp1) and at 6 hours (tp2) after stroke onset. Regions of reperfusion were defined by prolonged MTT at tp1 which normalized at tp2. Four MTT thresholds were assessed to ensure that results were not spuriously based on an arbitrary threshold. Baseline characteristics, relative reperfusion, and change in NIH Stroke Scale between tp1 and 1-month follow-up (ΔNIHSS) were compared between patients who were taking statins at stroke onset and those who were not. Results Thirty-one stroke patients were prospectively enrolled; 12 were taking statins, while 19 were not. Baseline characteristics did not differ between the two groups except the statin group had greater coronary artery disease (p=0.03). Patients using statins showed significantly greater reperfusion compared to untreated patients across all MTT thresholds. For MTT=4 seconds, median relative reperfusion was 50% (IQR 30%,56%) in the pre-existing statin group vs. 13% (IQR=5%,36%) in the untreated group, p=0.014. The statin group had greater ΔNIHSS (8.8±4.0 points) compared to the untreated group (4.4±5.7 points), p=0.028. Conclusion Statin use prior to ischemic stroke onset was associated with greater early reperfusion and NIHSS improvement. Further studies in larger populations are required to confirm our preliminary findings.

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

“…5 Furthermore, pre-existing statin treatment has been associated with greater reperfusion after acute stroke. 21 Overall, this may increase the risk of sICH, but may also result in improved clinical outcome. Interestingly, a recent study showed an association of pretreatment with statins and mild stroke severity on admission, which was pronounced in patients with high-dose statin therapy.…”

Ischemia-Reperfusion Injury in Stroke

“…Its protective effects were shown to be mediated by protein gp19phox in a rat model of ischemia-reperfusion and were also shown to diminish BBB disruption [111,112]. In patients, preliminary studies using MR perfusion in a group of 31 patients, 12 of whom had prior use of statins, was found to be associated with greater early reperfusion and clinical improvements both in patients who received tPA as well as those who did not [113]. This study did not, however, specifically address the effects of reperfusion injury in these patients.…”

Found in Translation

“…70 Statin treatment not only reduces stroke risk but also is associated with greater reperfusion and reduced severity of acute ischemic strokes, as well as improved poststroke survival. [75][76][77] Of particular importance, it has also been clearly demonstrated that acute discontinuation of statin treatment in patients with acute myocardial infarctions and stroke impairs vascular function, impairs recovery, and increases mortality.…”