Patra Devi P, Abi-Aad Karl R, Turcotte Evelyn L, Ogilvy Christopher S, Levy Elad I, Siddiqui Adnan H, Veznedaroglu Erol, Batjer H Hunt, Bendok Bernard R
Departments of1Neurological Surgery.
2Neurosurgery Simulation and Innovations Laboratory, Mayo Clinic, Phoenix, Arizona.
J Neurosurg. 2024 Dec 20;142(5):1366-1375. doi: 10.3171/2024.7.JNS24781. Print 2025 May 1.
Endovascular intracranial aneurysm (IA) management has significantly evolved over the last 2 decades. Despite these advancements, the aneurysm recanalization rate after coil embolization remains a concern. Statins have been found to affect vascular repair and remodeling; therefore, the authors hypothesized that patients receiving statin therapy at the time of coil embolization would have lower aneurysm recurrence and retreatment rates compared with patients not receiving statin therapy.
A post hoc analysis was conducted of the primary data from patients enrolled in the Hydrogel Endovascular Aneurysm Treatment Trial focusing on the impact of statin use on the recurrence rates of 3- to 14-mm IAs after endovascular coiling. The primary outcome measured included aneurysm recurrence over 18-24 months using the Raymond-Roy Occlusion Classification. Secondary outcomes included major and minor recurrence rates and retreatment rates. Propensity score matching based on patient and aneurysm characteristics was performed to mitigate selection bias.
A total of 577 patients with data on statin use were eligible for this analysis. Of these, 178 (30.8%) patients were using statins and 399 (69.2%) were not. After propensity score matching, 156 (39.2%) patients were included in the statin group and 242 (60.8%) in the nonstatin group. The recurrence rate was 3.8% (6/156) in the statin group and 10.7% (26/242) in the nonstatin group (p = 0.013). In a subgroup analysis, statin use significantly reduced recurrence in patients with unruptured aneurysms (1.6% vs 9.7%, p = 0.005), but not in those with ruptured aneurysms (12.5% vs 13.6%, p = 0.876).
Statin use was associated with a reduced rate of aneurysm recurrence in patients who underwent endovascular coiling for IAs with a decreased rate of retreatment during the follow-up period. Statins are a relatively low-risk treatment and may be an effective therapy to reduce recanalization of IAs, although further prospective studies are warranted to validate these findings.
在过去20年中，血管内治疗颅内动脉瘤（IA）有了显著进展。尽管有这些进展，但弹簧圈栓塞术后动脉瘤再通率仍是一个令人担忧的问题。已发现他汀类药物会影响血管修复和重塑；因此，作者推测，与未接受他汀类药物治疗的患者相比，在弹簧圈栓塞时接受他汀类药物治疗的患者动脉瘤复发率和再次治疗率会更低。
对参加水凝胶血管内动脉瘤治疗试验的患者的原始数据进行事后分析，重点关注他汀类药物的使用对血管内栓塞后3至14毫米IA复发率的影响。测量的主要结果包括使用雷蒙德-罗伊闭塞分类法评估18至24个月内的动脉瘤复发情况。次要结果包括主要和次要复发率以及再次治疗率。基于患者和动脉瘤特征进行倾向得分匹配，以减轻选择偏倚。
共有577例有他汀类药物使用数据的患者符合该分析条件。其中，178例（30.8%）患者使用他汀类药物，399例（69.2%）未使用。倾向得分匹配后，他汀类药物组纳入156例（39.2%）患者，非他汀类药物组纳入242例（60.8%）患者。他汀类药物组的复发率为3.8%（6/156），非他汀类药物组为10.7%（26/242）（p = 0.013）。在亚组分析中，他汀类药物的使用显著降低了未破裂动脉瘤患者的复发率（1.6%对9.7%，p = 0.005），但对破裂动脉瘤患者没有降低复发率（12.5%对13.6%，p = 0.876）。
他汀类药物的使用与接受IA血管内栓塞治疗患者的动脉瘤复发率降低相关，随访期间再次治疗率也降低。他汀类药物是一种相对低风险的治疗方法，可能是减少IA再通的有效疗法，尽管需要进一步的前瞻性研究来验证这些发现。
