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.
Highlights
Intracranial arterial stenosis (ICAS), an important cause of ischemic stroke, accounts for onethird of strokes in Asians who show a higher prevalence than Caucasians do. [1, 2] According to several Asian studies, intracranial arterial disease (IAD) accounts for 33–50%, 47%, 48%, and 10–25% of all stroke cases in China, Thailand, Singapore, and Korea, respectively.[3]
Statin therapy significantly prevented the progression of symptomatic basilar artery stenosis (BAS) (7.0% vs 28.2%) and induced regression (22.8% vs 15.4%) compared to non-statin users (p = 0.002)
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)
Summary
Intracranial arterial stenosis (ICAS), an important cause of ischemic stroke, accounts for onethird of strokes in Asians who show a higher prevalence than Caucasians do. [1, 2] According to several Asian studies, intracranial arterial disease (IAD) accounts for 33–50%, 47%, 48%, and 10–25% of all stroke cases in China, Thailand, Singapore, and Korea, respectively.[3]. [4,5,6] The prevalence of ischemic stroke in patients with symptomatic basilar artery stenosis (BAS) was reported to be 8.7% in Korea. [13] Several studies revealed preventive effect of statin after ischemic stroke with or without symptomatic intracranial atherosclerosis include middle cerebral artery or basilar artery. [17] we performed this study to retrospectively investigate the preventive effect of statin on the progression of symptomatic BAS and stroke recurrence. The exclusion criteria were: (1) embolic stroke or existence of high and medium risk of cardioembolism by trial of org 10172 in acute stroke treatment (TOAST classification) to investigate effect of statin on intracranial atherosclerosis. Symptomatic 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
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