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Giving statins ahead of carotid artery stenting (CAS) is associated with fewer periprocedural complications for patients with symptomatic carotid disease, new data show, suggesting that the drug class may offer the same benefits here as have been seen in other contexts.

“Statin pretreatment reduced the incidence of myocardial infarction after percutaneous coronary interventions and the risk of perioperative stroke and mortality after [carotid endarterectomy (CEA)],” write the authors, led by Jeong-Ho Hong, MD (Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea). Beyond a current lack of evidence on whether statins are useful in the CAS setting, they add, “It is also unknown whether statin pretreatment has dose-dependent effects on periprocedural complication risk in patients with CAS.”

The investigators evaluated outcomes of a consecutive series of 397 patients with symptomatic carotid artery stenosis of ≥ 50% on conventional angiography who underwent CAS at one of two tertiary university hospitals over a decade. Among these patients, statin pretreatment was divided into three categories based on the atorvastatin equivalent dose: none (n = 158, 39.8%), standard dose (< 40 mg of atorvastatin, n = 155, 39.0%), and high dose (≥ 40 mg, n = 84; 21.2%). The findings are published online June 16, 2017, ahead of print in Stroke. 

Patients’ mean age was 68.7 years, and 81.6% were men. The overall rate of periprocedural complications was 12.0% in the no-statin group, 4.5% in the standard-dose group, and 1.2% in the high-dose group. Multivariate logistic regression analysis revealed that statin use was an independent predictor of periprocedural complication risk.

Periprocedural Complications Statin Use vs No Statin

 

Adjusted OR (95% CI)

 

P Value

Standard Dose Statins

0.24 (0.07-0.81)

0.02

High Dose Statins

0.11 (0.01-0.96))

0.046


Antiplatelet drug use was also independently linked with a reduced complication risk (adjusted OR 0.18, 95% CI 0.05-0.69, P = 0.01).

Statin Pretreatment Recommended

“Our study indicated a dose-dependent effect of statins on risk reduction for periprocedural complications after CAS, independent of baseline lipid profiles,” conclude the authors. They speculate that statin therapy may improve atheroma stability, thus reducing the risk of releasing embolic debris from unstable or vulnerable plaques during stenting.

Limitations of the study, which the authors acknowledge, include its retrospective, nonrandomized design and the restriction only to those patients with symptomatic disease. The presence of asymptomatic embolic infarction was not confirmed with diffusion-weighted imaging. Additionally, because patients were treated at two different centers over 10 years, the multivariate analysis adjusted for differing center outcomes and learning curves.

Due to lack of evidence, current guidelines do not recommend statin use for carotid artery disease or a specific dose of the drugs prior to CAS, Hong et al point out. Based on the findings of this study, they advise giving a high-dose statin before CAS in patients with symptomatic carotid stenosis. They acknowledge, however, that the data do not permit them to make specific recommendations regarding duration of therapy and that the role of statins still needs to be evaluated in patients with asymptomatic disease.

 

Source:

Hong JH, Sohn SI, Kwak J, et al. Dose-dependent effect of statin pretreatment on preventing the periprocedural complications of carotid artery stenting. Stroke. 2017;Epub ahead of print.

 

Disclosures:

The study authors report no relevant conflicts of interest.

 

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