Objective Intracranial atherosclerosis is a major cause of ischaemic stroke worldwide. A number of studies have shown the effects of statin treatment on coronary and carotid artery plaques, but there is little evidence on the effects of statin treatment on intracranial atherosclerotic plaques.
Methods The Intensive Statin Treatment in Acute Ischaemic Stroke Patients with Intracranial Atherosclerosis - High-Resolution Magnetic Resonance Imaging (STAMINA-MRI) Trial is a single-arm, prospective, observational study monitoring imaging and clinical outcomes of high-dose statin treatment among statin-naive patients with acute ischaemic stroke caused by symptomatic intracranial atherosclerosis. The primary outcome was the change in vascular remodelling and plaque characteristics before and after 6 months (median: 179 days, IQR 163–189 days) of statin treatment measured by high-resolution MRI (HR-MRI).
Results A total of 77 patients (mean age: 62.6±13.7 years, 61.0% women) were included in this study. Low-density lipoprotein cholesterol (LDL-C) levels (mg/dL) at initial and follow-up assessments were 125.81±35.69 and 60.95±19.28, respectively. Overall, statin treatment significantly decreased enhancement of plaque volume (mm3, 32.07±39.15 vs 17.06±34.53, p=0.013), the wall area index (7.50±4.28 vs 5.86±4.05, p=0.016) and stenosis degree (%, 76.47±20.23 vs 64.05±21.29, p<0.001), but not the remodelling index (p=0.195). However, 35% patients showed no change or increased enhancement volume and stenosis degree after statin treatment. Higher reduction of LDL-C and longer duration of statin treatment were associated with decreased enhancement volume after statin treatment.
Conclusions High-dose statin treatment effectively stabilised symptomatic intracranial atherosclerotic plaques as documented by HR-MRI. Further study is needed to determine laboratory and genetic factors associated with poor response to statins and alternative therapeutic options, such as proprotein convertase subtilisin-kexin type 9 inhibitors, for these patients.
Trial registration number ClinicalTrials.gov NCT02458755.
- cerebral infarction
- intracranial atherosclerosis
- high-resolution MRI
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Presented at This study was presented at European Stroke Organization Conference 2018 as an oral presentation.
Contributors J-W Chung, the first author, established the study concept, analysed and interpreted the data, and wrote the manuscript; J Cha, MJ Lee, I-W Yu, MS Park, W-K Seo, ST Kim, SM Sung established study database and made critical revision of the manuscript; OY Bang, the corresponding author, established the study idea and database, and made critical revision of the manuscript with intellectual contents.
Funding The study was supported in part by funds from Samsung Medical Center(OTX000036) and Dong-A Pharma, Inc.(PHO112519) Seoul, South Korea.
Competing interests The statistical analysis was conducted by J-W Chung (Department of
Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine).
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.