Abstract
Statin therapy has been shown to induce carotid atherosclerotic plaque regression and reduce the periprocedural ischemic complications of carotid artery stenting (CAS). This study assessed the safety and usefulness of pretreatment using a high-dose strong statin (HDSS) to reduce the periprocedural ischemic complications of CAS. We analyzed 117 carotid lesions treated by CAS that were evaluated with magnetic resonance imaging (MRI) within 48 h after the procedure. For 67 lesions, an HDSS (rosuvastatin 20 mg or atorvastatin 40 mg daily) were prescribed from at least 14 days before CAS to at least 14 days after procedure (HDSS group). Clinical and angiographic data, as well as in-hospital outcomes, of the HDSS group were retrospectively compared with 50 lesions with conventional treatment without an HDSS (non-HDSS group). There were no significant differences in the baseline clinical and procedural characteristics between the two groups. There was no side effect related to the HDSS. Stroke rates were similar between the two groups (3.0% in HDSS group vs 8.0% in non-HDSS group, p = 0.22). All were minor strokes. Compared to the non-HDSS group, the HDSS group had a lower frequency of new lesions on diffusion-weighted imaging (DWI) with MRI (25.4% vs 44.0%, p = 0.0345). New ipsilateral DWI-positive rate in the HDSS group was significantly lower than in the non-HDSS group (16.4% vs 34.0%, p = 0.0275). Nonipsilateral (contralateral or posterior circulation) DWI-positive rates were similar between the two groups (13.4% vs 20.0%, p = 0.34). Pretreatment with an HDSS might reduce the periprocedural ischemic complications of CAS.
Similar content being viewed by others
Abbreviations
- CAS:
-
Carotid artery stenting
- CEA:
-
Carotid endarterectomy
- HDSS:
-
High-dose strong statin
- MRI:
-
Magnetic resonance imaging
- DWI:
-
Diffusion-weighted imaging
References
Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M, North American Symptomatic Carotid Endarterectomy Trial C (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325(7):445–453
Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339(20):1415–1425
Walker MD, Marler JR, Goldstein M, Grady PA, Toole JF, Baker WH, Castaldo JE, Chambless LE, Moore WS, Robertson JT, Young B, Howard VJ, Purvis S, Vernon DD, Needham K, Beck P, Celani VJ, Sauerbeck L, von Rajcs JA, Atkins D (1995) Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the asymptomatic carotid atherosclerosis study. JAMA 273(18):1421–1428
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K, Stenting, Angioplasty with Protection in Patients at High Risk for Endarterectomy I (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501
Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, Investigators C (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363(1):11–23
Yamada K, Yoshimura S, Kawasaki M, Enomoto Y, Asano T, Hara A, Minatoguchi S, Iwama T (2011) Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. Atherosclerosis 215(2):399–404
Zhao XQ, Dong L, Hatsukami T, Phan BA, Chu B, Moore A, Lane T, Neradilek MB, Polissar N, Monick D, Lee C, Underhill H, Yuan C (2011) MR imaging of carotid plaque composition during lipid-lowering therapy a prospective assessment of effect and time course. JACC Cardiovasc Imaging 4(9):977–986
Du R, Cai J, Zhao XQ, Wang QJ, Liu DQ, Leng WX, Gao P, Wu HM, Ma L, Ye P (2014) Early decrease in carotid plaque lipid content as assessed by magnetic resonance imaging during treatment of rosuvastatin. BMC Cardiovasc Disord 14:83
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J (2019) 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 139(25):e1046–e1081
Shinozaki N, Ogata N, Ikari Y (2014) Plaque protrusion detected by intravascular ultrasound during carotid artery stenting. J Stroke Cerebrovasc Dis 23(10):2622–2625
Ansel GM, Hopkins LN, Jaff MR, Rubino P, Bacharach JM, Scheinert D, Myla S, Das T, Cremonesi A (2010) Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 76(1):1–8
Montorsi P, Caputi L, Galli S, Ciceri E, Ballerini G, Agrifoglio M, Ravagnani P, Trabattoni D, Pontone G, Fabbiocchi F, Loaldi A, Parati E, Andreini D, Veglia F, Bartorelli AL (2011) Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58(16):1656–1663
Bijuklic K, Wandler A, Hazizi F, Schofer J (2012) The PROFI study (prevention of cerebral embolization by proximal balloon occlusion compared to filter protection during carotid artery stenting): a prospective randomized trial. J Am Coll Cardiol 59(15):1383–1389
Texakalidis P, Letsos A, Kokkinidis DG, Schizas D, Karaolanis G, Giannopoulos S, Economopoulos KP, Bakoyannis C (2018) Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: a systematic review and meta-analysis. Cardiovasc Revasc Med 19(5 Pt A):545–552
Okazaki S, Yokoyama T, Miyauchi K, Shimada K, Kurata T, Sato H, Daida H (2004) Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study. Circulation 110(9):1061–1068
Takayama T, Hiro T, Yamagishi M, Daida H, Hirayama A, Saito S, Yamaguchi T, Matsuzaki M, Investigators C (2009) Effect of rosuvastatin on coronary atheroma in stable coronary artery disease: multicenter coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS). Circ J 73(11):2110–2117
Hirayama A, Saito S, Ueda Y, Takayama T, Honye J, Komatsu S, Yamaguchi O, Li Y, Yajima J, Nanto S, Takazawa K, Kodama K (2009) Qualitative and quantitative changes in coronary plaque associated with atorvastatin therapy. Circ J 73(4):718–725
Takayama T, Komatsu S, Ueda Y, Fukushima S, Hiro T, Hirayama A, Saito S, group As (2016) Comparison of the effect of Rosuvastatin 2.5 mg vs 20 mg on Coronary Plaque determined by angioscopy and intravascular ultrasound in Japanese with stable angina pectoris (from the aggressive lipid-lowering treatment approach using intensive rosuvastatin for vulnerable coronary artery plaque [ALTAIR] randomized trial). Am J Cardiol 117(8), 1206–1212.
Takano H, Ohba T, Yamamoto E, Miyachi H, Inui K, Kawanaka H, Kamiya M, Kikuchi A, Takahashi Y, Tanabe J, Inami S, Takagi G, Asai K, Yasutake M, Ibuki C, Tanaka K, Kusama Y, Seino Y, Munakata K, Mizuno K, Investigators PS (2013) Usefulness of rosuvastatin to prevent periprocedural myocardial injury in patients undergoing elective coronary intervention. Am J Cardiol 111(12):1688–1693
Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T, Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering Study I (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 285(13):1711–1718
Dohi T, Miyauchi K, Okazaki S, Yokoyama T, Yanagisawa N, Tamura H, Kojima T, Yokoyama K, Kurata T, Daida H (2010) Early intensive statin treatment for six months improves long-term clinical outcomes in patients with acute coronary syndrome (Extended-ESTABLISH trial): a follow-up study. Atherosclerosis 210(2):497–502
Yun KH, Oh SK, Rhee SJ, Yoo NJ, Kim NH, Jeong JW (2011) 12-month follow-up results of high dose rosuvastatin loading before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol 146(1):68–72
Yun KH, Jeong MH, Oh SK, Rhee SJ, Park EM, Lee EM, Yoo NJ, Kim NH, Ahn YK, Jeong JW (2009) The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol 137(3):246–251
Wang Z, Dai H, Xing M, Yu Z, Lin X, Wang S, Zhang J, Hou F, Ma Y, Ren Y, Tan K, Wang Y, Ge Z (2013) Effect of a single high loading dose of rosuvastatin on percutaneous coronary intervention for acute coronary syndromes. J Cardiovasc Pharmacol Ther 18(4):327–333
Tsujita K, Sugiyama S, Sumida H, Shimomura H, Yamashita T, Yamanaga K, Komura N, Sakamoto K, Oka H, Nakao K, Nakamura S, Ishihara M, Matsui K, Sakaino N, Nakamura N, Yamamoto N, Koide S, Matsumura T, Fujimoto K, Tsunoda R, Morikami Y, Matsuyama K, Oshima S, Kaikita K, Hokimoto S, Ogawa H (2015) Impact of dual lipid-lowering strategy with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: the multicenter randomized controlled PRECISE-IVUS trial. J Am Coll Cardiol 66(5):495–507
Takayama K, Taki W, Toma N, Nakahara I, Maeda M, Tanemura H, Kuroiwa T, Imai K, Sakamoto M, Nakagawa I, Masuo O, Myouchin K, Wada T, Suzuki H (2014) Effect of pitavastatin on preventing ischemic complications with carotid artery stenting: a multicenter prospective study–EPOCH-CAS study. Cardiovasc Intervent Radiol 37(6):1436–1443
Verzini F, De Rango P, Parlani G, Giordano G, Caso V, Cieri E, Isernia G, Cao P (2011) Effects of statins on early and late results of carotid stenting. J Vasc Surg 53(1):71–79; discussion 79
Patti G, Tomai F, Melfi R, Ricottini E, Macri M, Sedati P, Giardina A, Aurigemma C, Leporace M, D'Ambrosio A, Di Sciascio G (2013) Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (clopidogrel and atorvastatin treatment during carotid artery stenting) study. J Am Coll Cardiol 61(13):1379–1387
Reiff T, Amiri H, Rohde S, Hacke W, Ringleb PA (2014) Statins reduce peri-procedural complications in carotid stenting. Eur J Vasc Endovasc Surg 48(6):626–632
Hong JH, Sohn SI, Kwak J, Yoo J, Chang HW, Kwon OK, Jung C, Chung I, Bae HJ, Lee JS, Han MK (2017) Dose-dependent effect of statin pretreatment on preventing the periprocedural complications of carotid artery stenting. Stroke 48(7):1890–1894
Gensicke H, van der Worp HB, Nederkoorn PJ, Macdonald S, Gaines PA, van der Lugt A, Mali WP, Lyrer PA, Peters N, Featherstone RL, de Borst GJ, Engelter ST, Brown MM, Bonati LH, Investigators I-MS (2015) Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol 65(6):521–529
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shinozaki, N., Murakami, T., Ohno, Y. et al. Effect of high-dose strong statin for preventing periprocedural ischemic complications of carotid artery stenting. Heart Vessels 35, 762–768 (2020). https://doi.org/10.1007/s00380-019-01552-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-019-01552-5