Abstract T MP117: Rosuvastatin May Have Long-Term Clinical Benefits by Causing Plaque Regression and Improving Aortic Stiffness in Ischemic Stroke Patients

Abstract

Background: Complicated aortic arch plaque (CAP) is important in recurrent ischemic stroke (IS) and prognosis. Keying on the reduced occurrence of IS observed in the large-cohort JUPITER Study, the current investigation assessed clinical benefits and pathophysiology of statin therapy. Methods: Of 112 consecutive acute cerebral embolism patients, 97 gave informed consent for our retrospective survey and were analyzed. All had transesophageal echocardiography (TEE) to assess presence or absence of CAP, defined as aortic wall thickness >4mm or plaque ulceration. Also assessed were aortic stiffness parameter β (Aoβ) and aortic arch wall motion velocity (WMV) evaluated by tissue Doppler imaging. Patients received appropriate conventional antithrombotic therapy as clinically indicated, and in addition we recommended that all patients with CAP receive 5 mg rosuvastatin/day. Patients were divided into 3 groups: those with CAP taking rosuvastatin (Group A, n=26, 68±7 years), those with CAP not taking rosuvastatin (Group B, n=13, 71±9 years), and those without CAP (Group C; n=58, 62±12 years). Follow-up TEE was performed at 6 months in Group A. In these 3 groups recurrent stroke and death were defined as major adverse cerebrovascular events (MACE). Results: Study duration was 710±405 days. CAP was detected in 39 patients (40%), and MACE occurred in 15 (15%). Kaplan-Meier analysis demonstrated that Group B had significantly higher MACE compare to other 2 groups (long-rank test; X2=6.553, p<0.05), while Group A did not differ from Group C despite being significantly older (p<0.05). Group A patients with a follow-up TEE at 6 months showed significant improvement in CAP diameter, Aoβ and peak WMV during the diastolic phase of contraction (5.8±2.0 vs. 4.9±1.9 mm, p<0.01; 19.5±14.6 vs. 12.9±6.5, p<0.05; 1.5±0.4 vs. 1.7±0.4 cm/s, p<0.01, respectively). In addition, CAP were morphologically improved in 15 patients, unchanged in 8, and worsened in 3. Conclusions: Rosuvastatin therapy causes plaque regression and improved aortic arch stiffness in IS patients with CAP, and may also have long-term clinical benefits.