Journal of Neurology

, Volume 256, Issue 2, pp 187–193 | Cite as

Effect of lipid-lowering therapy on the progression of intracranial arterial stenosis

ORIGINAL COMMUNICATION

Abstract

Objectives

Intracranial arterial stenosis (IAS) is a severe disease with a high recurrent stroke rate even under the best medical treatment. Statins have been demonstrated to prevent stroke and to slow or halt atherosclerosis progression. This study was performed to observe the effect of atorvastatin on the progression of IAS, explore the factors associated with atherosclerosis regression and the recurrent rate of stroke.

Methods

A hospital-base observation study enrolled 40 stroke patients with middle cerebral artery (MCA) or/and basilar artery (BA) stenosis. All participants had hyperlipidemia and were given atorvastatin 40 mg per day for at least six months. IAS was assessed by magnetic resonance angiogram (MRA) at the time of enrollment and then at least six months later. The primary outcome was the progression of IAS. All patients were also given antiplatelet agents for stroke prevention.

Results

At the end of the study, 23 (58 %), 15 (38 %) and 2 (4 %) patients had regressed, stationary and progressed IAS, respectively. Females were likely to have regressed IAS. The recurrent stroke rate was 18 %. Among the 54 stenotic vessels, 29 (54 %) vessels were assessed as improvement in stenosis.

Conclusion

Compared with other studies, more regressed, stationary IAS and less progressed IAS were found in our study. Female gender was likely to have regressed IAS after statin treatment. Further clinical outcome trials are required to assess the effects of such therapy on morbidity and mortality in this particular group of patients.

Key words

intracranial arterial stenosis stroke atherosclerosis statin 

References

  1. 1.
    Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41PubMedGoogle Scholar
  2. 2.
    Akins PT, Pilgram TK, Cross DT 3rd, Moran CJ (1998) Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke 29:433–438PubMedGoogle Scholar
  3. 3.
    Amarenco P, Labreuche J, Lavallee P, Touboul PJ (2004) Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke 35:2902–2909PubMedCrossRefGoogle Scholar
  4. 4.
    Arenillas JF, Molina CA, Montaner J, Abilleira S, Gonzalez-Sanchez MA, Alvarez-Sabin J (2001) Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke 32:2898–2904PubMedCrossRefGoogle Scholar
  5. 5.
    Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ, et al. (1995) The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 45:1488–1493PubMedGoogle Scholar
  6. 6.
    Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O’Leary DH, Grobbee DE, Bots ML (2007) Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. Jama 297:1344–1353PubMedCrossRefGoogle Scholar
  7. 7.
    de Groot E, Jukema JW, Montauban van Swijndregt AD, Zwinderman AH, Ackerstaff RG, van der Steen AF, Bom N, Lie KI, Bruschke AV (1998) B-mode ultrasound assessment of pravastatin treatment effect on carotid and femoral artery walls and its correlations with coronary arteriographic findings: a report of the Regression Growth Evaluation Statin Study (REGRESS). J Am Coll Cardiol 31:1561–1567PubMedCrossRefGoogle Scholar
  8. 8.
    Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR (1990) Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 40:1541–1545PubMedGoogle Scholar
  9. 9.
    Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, Smith HH, Nichols F, Rogg J, Cloft HJ, Wechsler L, Saver J, Levine SR, Tegeler C, Adams R, Sloan M (2007) The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology 68:2099–2106PubMedCrossRefGoogle Scholar
  10. 10.
    Jiang WJ, Wang YJ, Du B, Wang SX, Wang GH, Jin M, Dai JP (2004) Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke 35:1375–1380PubMedCrossRefGoogle Scholar
  11. 11.
    Kwon SU, Cho YJ, Koo JS, Bae HJ, Lee YS, Hong KS, Lee JH, Kim JS (2005) Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke 36:782–786PubMedCrossRefGoogle Scholar
  12. 12.
    Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E, Woimant F (2006) Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology 66:1187–1191PubMedCrossRefGoogle Scholar
  13. 13.
    Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, Kistler JP, Albers GW, Pettigrew LC, Adams HP Jr, Jackson CM, Pullicino P (2001) A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 345:1444–1451PubMedCrossRefGoogle Scholar
  14. 14.
    Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, Davignon J, Erbel R, Fruchart JC, Tardif JC, Schoenhagen P, Crowe T, Cain V, Wolski K, Goormastic M, Tuzcu EM (2006) Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. Jama 295:1556–1565PubMedCrossRefGoogle Scholar
  15. 15.
    Rodriguez-Granillo GA, Agostoni P, Garcia-Garcia HM, Biondi-Zoccai GG, McFadden E, Amoroso G, de Jaegere P, Bruining N, de Feyter P, Serruys PW (2007) Meta-analysis of the studies assessing temporal changes in coronary plaque volume using intravascular ultrasound. Am J Cardiol 99:5–10PubMedCrossRefGoogle Scholar
  16. 16.
    Rother J, Schwartz A, Rautenberg W, Hennerici M (1994) Middle cerebral artery stenoses: assessment by magnetic resonance angiography and transcranial Doppler ultrasound. Cerebrovasc Dis 4:273–279CrossRefGoogle Scholar
  17. 17.
    Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26:14–20PubMedGoogle Scholar
  18. 18.
    Salonen R, Nyyssonen K, Porkkala E, Rummukainen J, Belder R, Park JS, Salonen JT (1995) Kuopio Atherosclerosis Prevention Study (KAPS). A population- based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries. Circulation 92:1758–1764PubMedGoogle Scholar
  19. 19.
    Smilde TJ, van Wissen S, Wollersheim H, Trip MD, Kastelein JJ, Stalenhoef AF (2001) Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial. Lancet 357:577–581PubMedCrossRefGoogle Scholar
  20. 20.
    Tan TY, Tseng MC, Chang KC (2004) Risk factors for first-ever ischemic stroke: a hospital-based case-control study in Kaohsiung, Taiwan. Chang Gung Med J 27:801–807PubMedGoogle Scholar
  21. 21.
    Taylor AJ, Kent SM, Flaherty PJ, Coyle LC, Markwood TT, Vernalis MN (2002) ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation 106: 2055–2060PubMedCrossRefGoogle Scholar
  22. 22.
    Williams JE, Chimowitz MI, Cotsonis GA, Lynn MJ, Waddy SP (2007) Gender differences in outcomes among patients with symptomatic intracranial arterial stenosis. Stroke 38:2055–2062PubMedCrossRefGoogle Scholar
  23. 23.
    Wong KS, Li H (2003) Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis. Stroke 34:2361–2366PubMedCrossRefGoogle Scholar
  24. 24.
    Wong KS, Li H, Lam WW, Chan YL, Kay R (2002) Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke. Stroke 33:532–536PubMedCrossRefGoogle Scholar
  25. 25.
    Yonemura A, Momiyama Y, Fayad ZA, Ayaori M, Ohmori R, Higashi K, Kihara T, Sawada S, Iwamoto N, Ogura M, Taniguchi H, Kusuhara M, Nagata M, Nakamura H, Tamai S, Ohsuzu F (2005) Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging. J Am Coll Cardiol 45:733–742PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2009

Authors and Affiliations

  1. 1.Dept. of Neurology, Section of Cerebrovascular Disease, Chang Gung Memorial HospitalKaohsiung Medical Center, Chang Gung University College of MedicineKaohsiung County 833Taiwan
  2. 2.Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital-KaohsiungMedical Center, Chang Gung University College of MedicineKaohsiungTaiwan

Personalised recommendations