Previous Statin Use and High-Resolution Magnetic Resonance Imaging Characteristics of Intracranial Atherosclerotic Plaque

Abstract

Background and Purpose-Although statin use has been linked to the stabilization of systemic atherosclerosis, its effect on symptomatic intracranial atherosclerotic plaques has yet to be explored. We hypothesized that premorbid statin use is associated with plaque instability in intracranial arteries and may lead to differential patterns (size and distribution) of ischemic lesions in patients with acute intracranial atherosclerotic stroke. Methods-One hundred and thirty-six patients with acute infarcts caused by intracranial atherosclerotic stroke underwent high-resolution magnetic resonance imaging. Patients were categorized into 3 groups based on their premorbid statin use: nonuser, low-dose user, and high-dose user, according to the 2013 American College of Cardiology/American Heart Association guidelines on blood cholesterol. Symptomatic lesions in intracranial arteries were analyzed using highresolution magnetic resonance imaging for vascular morphology (degree of stenosis, remodeling index, and wall index) and plaque activation (pattern and volume of enhancement). The cortical distribution and volume of ischemic brain lesions were measured using diffusion-weighted imaging. Results-Among the enrolled patients, 38 (27.94%) were taking statins before the index stroke (22 low-dose statins and 16 high-dose statins). The degree of stenosis, remodeling index, and wall index did not differ between the 3 groups. However, the volume of plaque enhancement was significantly lower in statin users (nonuser, 33.26±40.72; low-dose user, 13.15±17.53; high-dose user, 3.13±5.26; P=0.002). Premorbid statin use was associated with a higher prevalence of nonembolic stroke and a decrease in large cortical infarcts (P=0.012). Conclusions-Premorbid

Distinct Roles of Endothelial Dysfunction and Inflammation in Intracranial Atherosclerotic Stroke

“…In the present study, there was a trend for the levels of serum ADMA (statin user, 0.68 ± 0.14; statin non-user, 0.72 ± 0.14; p = 0.07) and Lp-PLA 2 (statin user, 133.93 ± 120.29; statin non-user, 153.94 ± 101.99; p = 0.22) to be lower in patients taking statin medication before the onset of the index stroke. Further studies are needed in this context, because a recent high-resolution MRI study showed that the statin dosage prior to stroke was associated with plaque characteristics [29]. …”

Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging

“…Consequently, WA lesion /WA reference was used as the plaque burden in our study (Fig. 1), a ratio that has been referred to as the wall area index in previous studies2324. The arterial remodeling ratio was defined as the ratio of the OWA of the selected lesion site (OWA lesion ) to the OWA of the reference site (OWA reference ) (Fig.…”

Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke

“…Moreover, the proportion of IS due to plaque rupture was lower among premorbid statin users. Unfortunately, no evaluation was done with regard to the impact of statins on the reduction of the incidence of IS in patients with intracranial atherosclerosis and no clinical improvement was highlighted among premorbid statin-treated patients at 90 days after IS [305]. Many observations demonstrated that pre-treatment with statins improves stroke outcome at 90 days and this benefit is evident across all the stroke subtypes [306,307], as confirmed by the meta-analysis by Biffi et al, especially in patients with small vessel stroke disease, and Ní Chróinín et al [308].…”