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Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: A meta-analysis

      Highlights

      • Collateral circulation status and final infarct volume (FIV) are independent outcome predictors after an AIS.
      • We evaluated the association of statin pretreatment (SP) on collateral circulation and FIV in AIS patients.
      • SP was associated with lower FIV compared to no SP, especially in atherosclerotic AIS.
      • A trend towards good collateral scores was observed in the SP group.
      • SP appears to be associated with decreased FIV after AIS, possibly due to more favorable collateral circulation.

      Abstract

      Background and aims

      Statin pretreatment (SP) is associated with improved outcomes in acute ischemic stroke (AIS) patients. Collateral circulation status and final infarct volume (FIV) are independent predictors of functional outcome in AIS.

      Methods

      We sought to evaluate the association of SP with collateral circulation and FIV in AIS patients. We used a random-effects model for all the analyses, and pooled standardized mean differences (SMDs) and odds ratios (OR) on the FIV and collateral status according to SP history, respectively.

      Results

      We identified 9 eligible studies (1186 AIS patients). History of SP was associated with lower FIV (SMD = 0.25, 95%CI: 0.07–0.42, p = 0.005) compared to negative history of SP. A trend towards good collateral scores was observed in the SP group (OR = 1.45; 95% CI, 0.92–2.29, p = 0.11). Subgroup analysis demonstrated reduced FIV among atherosclerotic stroke patients with history of SP (SMD = 0.49; 95% CI, 0.19–0.80, p = 0.001).

      Conclusions

      SP appears to be associated with decreased FIV, especially in atherosclerotic AIS.
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      References

        • Tsivgoulis G.
        • Katsanos A.H.
        • Sharma V.K.
        • Krogias C.
        • Mikulik R.
        • Vadikolias K.
        • et al.
        Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke.
        Neurology. 2016; 86: 1103-1111
        • Sargento-Freitas J.
        • Pagola J.
        • Rubiera M.
        • Flores A.
        • Silva F.
        • Rodriguez-Luna D.
        • et al.
        Preferential effect of premorbid statins on atherothrombotic strokes through collateral circulation enhancement.
        Eur. Neurol. 2012; 68: 171-176
        • Safouris A.
        • Katsanos A.H.
        • Kerasnoudis A.
        • Krogias C.
        • Kinsella J.A.
        • Sztajzel R.
        • et al.
        Statin pretreatment and microembolic signals in large artery atherosclerosis: a systematic review and meta-analysis.
        Stroke. 2018; 49: 1992-1995
        • Ovbiagele B.
        • Saver J.L.
        • Starkman S.
        • Kim D.
        • Ali L.K.
        • Jahan R.
        • et al.
        Statin enhancement of collateralization in acute stroke.
        Neurology. 2007; 68: 2129-2131
        • Lee M.J.
        • Bang O.Y.
        • Kim S.J.
        • Kim G.M.
        • Chung C.S.
        • Lee K.H.
        • et al.
        Role of statin in atrial fibrillation-related stroke: an angiographic study for collateral flow.
        Cerebrovasc. Dis. (Basel, Switzerland). 2014; 37: 77-84
        • Shook S.J.
        • Gupta R.
        • Vora N.A.
        • Tievsky A.L.
        • Katzan I.
        • Krieger D.W.
        Statin use is independently associated with smaller infarct volume in nonlacunar mca territory stroke.
        J. Neuroimaging: Off. J. Am. Soc. Neuroimaging. 2006; 16: 341-346
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gotzsche P.C.
        • Ioannidis J.P.
        • et al.
        The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J. Clin. Epidemiol. 2009; 62: e1-34
        • Katsanos A.H.
        • Parissis J.
        • Frogoudaki A.
        • Vrettou A.R.
        • Ikonomidis I.
        • Paraskevaidis I.
        • et al.
        Heart failure and the risk of ischemic stroke recurrence: a systematic review and meta-analysis.
        J. Neurol. Sci. 2016; 362: 182-187
        • Liebeskind D.S.
        • Tomsick T.A.
        • Foster L.D.
        • Yeatts S.D.
        • Carrozzella J.
        • Demchuk A.M.
        • et al.
        Collaterals at angiography and outcomes in the interventional management of stroke (ims) iii trial.
        Stroke. 2014; 45: 759-764
        • Higgins J.P.
        • Green S.
        Cochrane Handbook for Systematic Reviews of Interventions.
        2005
        • Goyal N.
        • Tsivgoulis G.
        • Iftikhar S.
        • Khorchid Y.
        • Fawad Ishfaq M.
        • Doss V.T.
        • et al.
        Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment.
        J. Neurointerventional Surg. 2017; 9: 451-454
        • Chung J.W.
        • Hwang J.
        • Lee M.J.
        • Cha J.
        • Bang O.Y.
        Previous statin use and high-resolution magnetic resonance imaging characteristics of intracranial atherosclerotic plaque: the intensive statin treatment in acute ischemic stroke patients with intracranial atherosclerosis study.
        Stroke. 2016; 47: 1789-1796
        • Sheth S.A.
        • Sanossian N.
        • Hao Q.
        • Starkman S.
        • Ali L.K.
        • Kim D.
        • et al.
        Collateral flow as causative of good outcomes in endovascular stroke therapy.
        J. Neurointerventional Surg. 2016; 8: 2-7
        • Cheng-Ching E.
        • Frontera J.A.
        • Man S.
        • Aoki J.
        • Tateishi Y.
        • Hui F.K.
        • et al.
        Degree of collaterals and not time is the determining factor of core infarct volume within 6 hours of stroke onset.
        AJNR. Am. J. Neuroradiol. 2015; 36: 1272-1276
        • Safouris A.
        • Kargiotis Ο.
        • Psychogios K.
        • Spiliopoulos S.
        • Palialexis K.
        • et al.
        Baseline collateral circulation is associated with early outcomes in patients with large-vessel occlusion acute ischemic stroke treated with mechanical thrombectomy.
        Νevrologia. 2018; 27: 6-13
        • Menon B.K.
        • Smith E.E.
        • Coutts S.B.
        • et al.
        Leptomeningeal collaterals are associated with modifiable metabolic risk factors.
        Ann. Neurol. 2013; 74: 241-248
        • Liebeskind D.S.
        • Jahan R.
        • Nogueira R.G.
        • et al.
        Early arrival at the emergency department is associated with better collaterals, smaller established infarcts and better clinical outcomes with endovascular stroke therapy: SWIFT study.
        J. Neurointerventional Surg. 2016; 8: 553-558