Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: A meta-analysis
Introduction
Statin pretreatment (SP) is associated with favorable clinical outcomes in acute ischemic stroke (AIS) due to large artery atherosclerosis (LAA) [1]. Pleiotropic properties of statins extend beyond lipid lowering effects, encompassing positive influence on endothelial function, cerebral hemodynamics, inflammatory response, platelet function and lipid oxidation [2]. These tissue-level effects further correspond to atherosclerotic plaque stabilization and reduction in stroke recurrence [3]. There are preliminary data showing that SP may be correlated with improved collateralization among AIS patients [4,5]. Moreover, SP have been demonstrated to up-regulate endothelial nitric oxide synthase (eNOS) activity that further enhances collateral perfusion and reduces final infarct volumes (FIV) [6]. Although improved collateral circulation results in reduction of FIV and better clinical outcomes, the potential influence of SP on collateral circulation status and final infarct size has not been determined. In view of these considerations, we performed a systematic review and meta-analysis of available studies reporting FIV or collateral grades based on digital subtraction angiography (DSA) in AIS patients with and without SP.
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Materials and methods
We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses [7]. We used the Newcastle-Ottawa Scale to explore sources of bias amongst the included observational studies as previously described [8].
We identified all eligible observational studies that investigated the association of statin pre-treatment (SP) prior to admission with collateral circulation and core infarct volume. Systematic search was conducted in
Results
The systematic search of Embase/MEDLINE and Scopus databases yielded 429 and 309 results respectively. After removing duplicates, the titles and abstracts of the remaining 730 studies were screened and, from the 16 potentially eligible studies, 7 studies were excluded for lack of data availability on either collateral scores or infarct volume stratified by SP status (Supplementary Table I). In the final evaluation of the literature search results, there was no conflict or disagreement between
Discussion
To the best of our knowledge, this is the first meta-analysis demonstrating the beneficial effect of SP among AIS patients in regards to reduced infarct volume. Prior studies have demonstrated improved collateral circulation with SP among acute LAA [2] or cardioembolic strokes [4,5]. These beneficial effects are likely attributed to the potential for statins to promote arteriogenesis and augment the eNOS-mediated vasodilation [6]. Among AIS patients with symptomatic intracranial atherosclerotic
Conflicts of interest
The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.
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