Acta Neurochirurgica

, Volume 160, Issue 9, pp 1761–1771 | Cite as

Systematic review and meta-analysis of perioperative and long-term outcomes in patients receiving statin therapy before carotid endarterectomy

  • Natasha IronsideEmail author
  • Daniel Brenner
  • Eric Heyer
  • Ching-Jen Chen
  • Trae Robison
  • Brandon Christophe
  • Edward Sander Connolly
Review Article - Vascular Neurosurgery - Other
Part of the following topical collections:
  1. Vascular Neurosurgery – Other



Carotid endarterectomy (CEA) is associated with perioperative stroke and mortality in a minority of cases. The aim of this systematic review and meta-analysis was to investigate the effect of pre-operative statins on perioperative outcomes in patients undergoing CEA for internal carotid artery (ICA) stenosis.


A systematic review of PubMed, Medline, and the Cochrane Database of Systematic Reviews was performed. Studies were included which reported perioperative stroke and/or survival outcomes following CEA for ICA stenosis and compared patients who were and were not taking pre-operative statins. Relevant data were extracted and pooled using meta-analysis.


Seven studies met the inclusion criteria, comprising 21,387 patients. A total of 68.9% (14,976) were administered statins and 31.1% (6657) were statin-free. Pre-operative statin use was higher in patients with a history of cardiac disease (12.2 vs. 23.6% in the statin-free group), diabetes (31.6 vs. 25.1% in the statin-free group), and hypertension (83.5 vs. 72.2% in the statin-free group), while a greater proportion of statin-free patients had symptomatic disease (44.9 vs. 55.5% in the statin-free group). Statins were associated with reduced perioperative stroke in all patients (OR 0.57; 95% CI 0.34–0.95; p = 0.03) and in symptomatic patients (OR 0.57; 95% CI 0.35–0.93; p = 0.03). A trend towards lower perioperative mortality (OR 0.54; 95% CI 0.29, 1.03; p = 0.06) and significantly improved overall survival was observed in the statin group (HR 0.69; 95% CI 0.59–0.81; p < 0.001) at a mean follow-up of 62 months (range 27–76 months).


Administration of statins before CEA is associated with lower rates of perioperative stroke and improved overall survival. Compliance with optimal medical treatment associated with the use of pre-operative statins may limit the clinical significance of these findings. Future investigation to characterize the potential benefit of statin therapy in patients undergoing CEA for ICA stenosis is warranted.


Carotid endarterectomy Statin Survival Outcome Morbidity Mortality 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

701_2018_3618_MOESM1_ESM.docx (251 kb)
Fig. S1 (DOCX 250 kb)
701_2018_3618_MOESM2_ESM.docx (142 kb)
Fig. S2 (DOCX 141 kb)
701_2018_3618_MOESM3_ESM.docx (15 kb)
Table S1 (DOCX 14 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurological SurgeryColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Neurological SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA

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