Standard-Dose Atorvastatin Treatment in Patients With Symptomatic Middle Cerebral Artery Atherosclerotic Stenosis: A Vessel Wall Magnetic Resonance Imaging Study.

Yejun Wu,Yilin Wang,Tianxiang Hu,Honghua Gao,Fangbing Li

doi:10.3389/fneur.2021.693397

Abstract

Background and Purpose: Ischemic stroke can be caused by atherosclerotic lesions of the middle cerebral artery (MCA). Some studies have described the effects of statin treatment on carotid artery plaques, but little is known about the effects of statin treatment on MCA plaques. The purpose of this study was to validate the efficacy of standard-dose atorvastatin (20 mg/day) in patients with symptomatic MCA atherosclerotic stenosis (SMAS) in northern China.Materials and Methods: This study is a prospective, single-arm, single-center, 12-month follow-up observational study monitoring imaging, and clinical outcomes of standard-dose atorvastatin treatment among patients with SMAS. The primary outcomes were changes in vessel wall magnetic resonance imaging (VWMRI) and serum lipid profiles before and after (1, 3, 6, and 12 months) statin treatment.Results: A total of 46 patients were recruited for this study, and 24 patients completed the follow-up. During the follow-up period, serum non-high-density lipoprotein cholesterol concentrations gradually decreased in the patients. Fourteen patients (54.33%) had a reversal of MCA plaques and 10 patients (41.67%) had no significant progression of MCA plaques and remained stable at the follow-up endpoint. At the 12 months follow-up time-point, the treatment did not reverse vascular remodeling or change the shape and distribution of plaques. Altered serum low-density lipoprotein cholesterol (LDL-C) concentrations in patients were strongly associated with plaque reversal.Conclusion: Vessel wall magnetic resonance imaging could accurately characterize changes in MCA plaques after lipid-lowering therapy. Standard-dose atorvastatin treatment could stabilize and reverse plaques in northern Chinese patients with SMAS.

Highlights

Intracranial atherosclerotic disease (ICAD) is one of the major causes of ischemic stroke worldwide, and it is more common in the Chinese population [1]
This study is a 12-month single-center, single-arm, prospective, observational study focused on monitoring changes in imaging and clinical outcomes in patients with symptomatic MCA atherosclerotic stenosis (SMAS) who were taking standard doses of atorvastatin (Lipitor, Pfizer, Inc., USA; 20 mg/day)
This study used VWMRI evaluation of plaques in patients in northern China with SMAS. It was a single-center, singlearm, prospective observational study that monitored imaging outcomes and clinical parameters in patients treated with standard doses of atorvastatin over a 12-month follow-up period

Summary

Introduction

Intracranial atherosclerotic disease (ICAD) is one of the major causes of ischemic stroke worldwide, and it is more common in the Chinese population [1]. The middle cerebral artery (MCA) is an important branch of the intracranial carotid artery and is most susceptible to atherosclerotic lesions. Intracranial atherosclerotic disease can cause cerebral tissue ischemia, and a variety of neurological symptoms through the following mechanisms: occlusion of blood vessels by thrombi, occlusion of small penetrating arteries, artery-to-artery embolism due to plaque rupture, and inadequate perfusion of brain tissue due to intracranial arterial stenosis [2]. Ischemic stroke can be caused by atherosclerotic lesions of the middle cerebral artery (MCA). Some studies have described the effects of statin treatment on carotid artery plaques, but little is known about the effects of statin treatment on MCA plaques. The purpose of this study was to validate the efficacy of standard-dose atorvastatin (20 mg/day) in patients with symptomatic MCA atherosclerotic stenosis (SMAS) in northern China

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Conclusion