Yum Kyu Sun, Chang Jun Young, Jeong Won Joo, Lee Sangkil, Jeong Jin-Heon, Yeo Min-Ju, Hong Jeong-Ho, Park Hong-Kyun, Chung Inyoung, Kim Beom Joon, Bang Jae Seung, Bae Hee-Joon, Han Moon-Ku
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea.
PLoS One. 2017 Oct 11;12(10):e0183798. doi: 10.1371/journal.pone.0183798. eCollection 2017.
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.
We 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.
Of 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).
Our 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.
有症状的基底动脉狭窄（BAS）与缺血性卒中复发的高风险相关。我们旨在研究他汀类药物治疗是否可以预防有症状BAS的进展及卒中复发。
我们回顾性分析了有症状BAS的急性缺血患者的数据，这些患者在入院当天及1年后（或临床事件发生当天）接受了磁共振血管造影（MRA）成像评估。临床终点为复发性缺血性卒中及其复合事件、短暂性脑缺血发作、冠心病和血管性死亡。
在153例有症状BAS患者中，114例（74.5%）在卒中后接受了他汀类药物治疗。与未使用他汀类药物的患者相比，他汀类药物治疗显著预防了有症状BAS的进展（7.0%对28.2%）并导致其逆转（22.8%对15.4%）（p = 0.002）。有31例缺血性卒中事件和38例复合血管事件。使用他汀类药物的患者卒中复发率（14.9%对35.9%，p = 0.05）和复合血管事件发生率（17.5%对46.2%；比值比[OR]，0.29；95%置信区间[CI]，0.13 - 0.64）显著低于未使用他汀类药物的患者。基底动脉区域复发性卒中和复合血管事件在BAS进展的患者中比在其他患者中更常见（OR，5.16；95% CI，1.63 - 16.25对OR，4.2；95% CI，1.56 - 11.34）。
我们的研究表明，他汀类药物治疗可能预防有症状BAS的进展并降低随后缺血性卒中的风险。需要大型随机试验来证实这一结果。
