El Seblani Nader, Kalra Saurabh, Kalra Deepak, Al-Mufti Fawaz, Nagaraja Nandakumar
Department of Neurology, Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, USA.
Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
Clin Neurol Neurosurg. 2025 Feb;249:108724. doi: 10.1016/j.clineuro.2025.108724. Epub 2025 Jan 5.
Acute large vessel occlusions (LVOs) account for up to one-third of acute ischemic strokes (AIS) and are associated with high mortality and severe functional deficits. Animal model research suggests that statins may have a protective effect on vessel wall injury during endovascular thrombectomy (EVT). We conducted a retrospective observational study to assess the impact of statin use on clinical outcomes post-EVT in AIS patients with LVOs.
Using the Global Collaborative Network consisting of about 143 million patients in TriNetX database, we identified adult AIS patients who underwent EVT between 2018 and 2023. Patients were categorized based on any statin use (atorvastatin, simvastatin, rosuvastatin, pravastatin, lovastatin, or pitavastatin) in the 3 months before AIS admission. The primary outcome was all-cause mortality at one-week post-EVT. Secondary outcomes included intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), decompressive hemicraniectomy procedure (DHC), and aspiration pneumonia at one-week post-EVT. Propensity score matching balanced relevant medical history, stroke severity, medications, and demographics. Cox proportional hazard regression analysis compared outcomes between statin and non-statin cohorts.
We identified 17,774 patients who received EVT for LVO ischemic stroke. A total of 10,678 patients were on statins during 3 months prior to EVT and 7096 patients were not on statins. After 1:1 propensity matching, 2148 patients were included in each group. AIS patients treated with EVT and on statins had lower risk of all-cause mortality [7 % vs. 17 %; HR 0.43, 95 % CI 0.35-0.51], ICH [10 % vs. 15 %; HR 0.64, 95 % CI 0.51-0.74], SAH [3 % vs. 6 %; HR 0.48, 95 % CI 0.35-0.64], and aspiration pneumonia [4 % vs 8 %; HR 0.53, 95 % CI 0.41-0.70] compared to AIS patients treated with EVT but not on statins. Rates of DHC were similar between groups [2 % vs 2 %; HR 0.81; 95 % CI (0.52,1.25)].
Statin use within 3 months prior to AIS was associated with better survival and lesser intracranial bleeding risks and complications following EVT. Future studies may help examine how the duration or dosages of statins or LDL levels on admission affect outcomes in LVO strokes treated with EVT.
急性大血管闭塞（LVO）占急性缺血性卒中（AIS）的比例高达三分之一，并与高死亡率和严重功能缺陷相关。动物模型研究表明，他汀类药物可能对血管内血栓切除术（EVT）期间的血管壁损伤具有保护作用。我们进行了一项回顾性观察研究，以评估他汀类药物的使用对LVO型AIS患者EVT术后临床结局的影响。
利用TriNetX数据库中约1.43亿患者组成的全球协作网络，我们确定了2018年至2023年间接受EVT的成年AIS患者。根据AIS入院前3个月内是否使用任何他汀类药物（阿托伐他汀、辛伐他汀、瑞舒伐他汀、普伐他汀、洛伐他汀或匹伐他汀）对患者进行分类。主要结局是EVT术后1周的全因死亡率。次要结局包括EVT术后1周的脑出血（ICH）、蛛网膜下腔出血（SAH）、减压性颅骨切除术（DHC）和吸入性肺炎。倾向评分匹配平衡了相关病史、卒中严重程度、药物治疗和人口统计学特征。Cox比例风险回归分析比较了他汀类药物组和非他汀类药物组的结局。
我们确定了17774例接受LVO缺血性卒中EVT治疗的患者。共有10678例患者在EVT前3个月内使用他汀类药物，7096例患者未使用他汀类药物。经过1:1倾向匹配后，每组纳入2148例患者。与接受EVT但未使用他汀类药物的AIS患者相比，接受EVT且使用他汀类药物治疗的AIS患者全因死亡率[7%对17%；风险比（HR）0.43，95%置信区间（CI）0.35 - 0.51]、ICH[10%对15%；HR 0.64，95% CI 0.51 - 0.74]、SAH[3%对6%；HR 0.48，95% CI 0.35 - 0.64]和吸入性肺炎[4%对8%；HR 0.53，95% CI 0.41 - 0.70]的风险更低。两组间DHC发生率相似[2%对2%；HR 0.81；95% CI（0.52，1.25）]。
AIS前3个月内使用他汀类药物与EVT术后更好的生存率以及更低的颅内出血风险和并发症相关。未来的研究可能有助于探讨他汀类药物的使用时长或剂量或入院时的低密度脂蛋白水平如何影响接受EVT治疗的LVO卒中的结局。
