Takayama Katsutoshi, Taki Waro, Toma Naoki, Nakahara Ichiro, Maeda Masayuki, Tanemura Hiroshi, Kuroiwa Terumasa, Imai Keisuke, Sakamoto Masahiko, Nakagawa Ichiro, Masuo Osamu, Myouchin Kaoru, Wada Takeshi, Suzuki Hidenori
Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, 1-41 Numa Yao, Osaka, 581-0036, Japan,
Cardiovasc Intervent Radiol. 2014 Dec;37(6):1436-43. doi: 10.1007/s00270-013-0813-x. Epub 2013 Dec 10.
Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS.
In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic ≥50%, asymptomatic ≥80%) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C ≥120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C <120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed.
Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8%) in the PS group and 16 of 30 patients (53.3%) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0%) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (β = 0.74, 95% confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.
Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.
围手术期缺血性卒中是与颈动脉支架置入术（CAS）相关的一个问题。本研究旨在评估术前他汀类药物治疗是否能降低CAS围手术期缺血性并发症的风险。
在这项于11个中心开展的前瞻性研究中，将有颈动脉狭窄（有症状者≥50%，无症状者≥80%）且颈动脉内膜切除术风险高但既往未接受他汀类药物治疗的患者，根据低密度脂蛋白胆固醇（LDL-C）水平分为两组。LDL-C≥120mg/dl时，匹伐他汀治疗（PS）组接受4mg/天的匹伐他汀治疗。LDL-C<120mg/dl时，非PS组不接受他汀类药物治疗。4周后，两组均接受CAS。评估CAS后72小时内弥散加权成像上新发同侧缺血性病变的频率以及30天内脑血管事件（短暂性脑缺血发作、卒中或死亡）的发生情况。
在纳入的80例患者中，61例患者（PS组，n = 31；非PS组，n = 30）符合纳入标准。PS组31例患者中有8例（25.8%）发现新发同侧缺血性病变，非PS组30例患者中有16例（53.3%）发现新发同侧缺血性病变（P = 0.028）。PS组0例患者发生脑血管事件，非PS组30例患者中有3例（10.0%）发生脑血管事件（P = 0.071）。多因素分析表明，匹伐他汀治疗（β = 0.74，95%置信区间0.070 - 1.48，P = 0.042）是降低CAS术后缺血性病变的独立因素。
匹伐他汀预处理显著降低了CAS围手术期缺血性并发症的发生率。
