Abstract
BackgroundWe aimed to determine whether early statin use following recanalization therapy improves the functional outcome of ischemic stroke.MethodsUsing a prospective stroke registry database, we identified a consecutive 337 patients within 6 h of onset who had symptomatic stenosis or occlusion of major cerebral arteries and received recanalization therapy. Based on commencement of statin therapy, patients were categorized into administration on the first (D1, 13.4 %), second (D2, 20.8 %) and third day or later (D ≥ 3, 15.4 %) after recanalization therapy, and no use (NU, 50.4 %). The primary efficacy outcome was a 3-month modified Rankin Scale score of 0–1, and the secondary outcomes were neurologic improvement, neurologic deterioration and symptomatic hemorrhagic transformation during hospitalization.ResultsEarlier use of statin was associated with a better primary outcome in a dose-response relationship (P for trend = 0.01) independent of premorbid statin use, stroke history, atrial fibrillation, stroke subtype, calendar year, and methods of recanalization therapy. The odds of a better primary outcome increased in D1 compared to NU (adjusted odds ratio, 2.96; 95 % confidence interval, 1.19–7.37). Earlier statin use was significantly associated with less neurologic deterioration and symptomatic hemorrhagic transformation in bivariate analyses but not in multivariable analyses. Interaction analysis revealed that the effect of early statin use was not altered by stroke subtype and recanalization modality (P for interaction = 0.97 and 0.26, respectively).ConclusionEarly statin use after recanalization therapy in ischemic stroke may improve the likelihood of a better functional outcome without increasing the risk of intracranial hemorrhage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0367-4) contains supplementary material, which is available to authorized users.
Highlights
We aimed to determine whether early statin use following recanalization therapy improves the functional outcome of ischemic stroke
Among 501 patients with acute ischemic stroke who were hospitalized within 6 h of onset and who underwent recanalization therapy, 345 had symptomatic stenosis or occlusion of major cerebral arteries at initial angiographic evaluation
Comparison of baseline characteristics revealed that atrial fibrillation, stroke subtype and recanalization modality were associated with the statin starting time (Table 1)
Summary
We aimed to determine whether early statin use following recanalization therapy improves the functional outcome of ischemic stroke. Since the introduction of intravenous (IV) thrombolysis, additional attempts have been made with a new generation of thrombectomy devices that show much higher successful recanalization rates [2, 3] This improvement is in discord with clinical outcome; only ~ 30–40 % of ischemic stroke. Kang et al BMC Neurology (2015) 15:122 early statin administration enhances thrombolysis, augments antithrombotic responses, increases cerebral blood flow, and decreases matrix metalloproteinase-9 (MMP-9) levels [11,12,13,14]. These actions predispose the prevention of re-occlusion and improve the prospects for brain perfusion. The effects of statin may be maximized in patients who present with acute steno-occlusion of the major cerebral arteries and are treated successfully with recanalization therapy, including endovascular approaches
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