Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis

Apostolos Safouris, Aristeidis H. Katsanos, Antonios Kerasnoudis, Christos Krogias, Justin A. Kinsella, Roman Sztajzel, Vaia Lambadiari, Spyridon Deftereos, Odysseas Kargiotis, Vijay K. Sharma, Andrew M. Demchuk, Maher Saqqur, Dominick J.H. McCabe, Georgios Tsivgoulis

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Abstract

Background and Purpose-Scarce data indicate that statin pretreatment (SP) in patients with acute cerebral ischemia because of large artery atherosclerosis may be related to lower risk of recurrent stroke because of a decreased incidence of microembolic signals (MES) during transcranial Doppler monitoring. Methods-We performed a systematic review and meta-analysis of available observational studies reporting MES presence/absence or MES burden, categorized according to SP status, in patients with acute cerebral ischemia because of symptomatic (≥50%) large artery atherosclerosis. In studies with partially-published data, authors were contacted for previously unpublished information. We also performed a sensitivity analysis of studies with data on MES burden categorized according to SP status, and an additional subgroup analysis in patients receiving higher-dose SP (atorvastatin 80 mg or rosuvastatin 40 mg daily). Results-Seven eligible study protocols were identified (610 patients, 54% with SP). SP was associated with a reduced risk of MES detection during transcranial Doppler monitoring (risk ratio=0.67; 95% CI, 0.45-0.98), with substantial heterogeneity between studies (I2=52%). In studies reporting MES burden (n=4), a significantly lower number of MES were identified in patients with compared with those without SP (mean difference=−0.92; 95% CI, −1.64 to -0.19), with no evidence of heterogeneity between studies (I2=49%). Subgroup analysis revealed that higher-dose SP reduced the risk of detecting MES (risk ratio=0.23; 95% CI, 0.06-0.88), with no evidence of heterogeneity between studies (I2=0%). Conclusions-SP seems to be associated with a lower incidence and burden of MES in patients with acute cerebral ischemia because of large artery atherosclerosis.

Original languageEnglish (US)
Pages (from-to)1992-1995
Number of pages4
JournalStroke
Volume49
Issue number8
DOIs
StatePublished - Jan 1 2018

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Meta-Analysis
Atherosclerosis
Arteries
Brain Ischemia
Odds Ratio
Incidence
Observational Studies
Stroke

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis. / Safouris, Apostolos; Katsanos, Aristeidis H.; Kerasnoudis, Antonios; Krogias, Christos; Kinsella, Justin A.; Sztajzel, Roman; Lambadiari, Vaia; Deftereos, Spyridon; Kargiotis, Odysseas; Sharma, Vijay K.; Demchuk, Andrew M.; Saqqur, Maher; McCabe, Dominick J.H.; Tsivgoulis, Georgios.

In: Stroke, Vol. 49, No. 8, 01.01.2018, p. 1992-1995.

Research output: Contribution to journalArticle

Safouris, A, Katsanos, AH, Kerasnoudis, A, Krogias, C, Kinsella, JA, Sztajzel, R, Lambadiari, V, Deftereos, S, Kargiotis, O, Sharma, VK, Demchuk, AM, Saqqur, M, McCabe, DJH & Tsivgoulis, G 2018, 'Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis', Stroke, vol. 49, no. 8, pp. 1992-1995. https://doi.org/10.1161/STROKEAHA.118.021542
Safouris A, Katsanos AH, Kerasnoudis A, Krogias C, Kinsella JA, Sztajzel R et al. Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis. Stroke. 2018 Jan 1;49(8):1992-1995. https://doi.org/10.1161/STROKEAHA.118.021542
Safouris, Apostolos ; Katsanos, Aristeidis H. ; Kerasnoudis, Antonios ; Krogias, Christos ; Kinsella, Justin A. ; Sztajzel, Roman ; Lambadiari, Vaia ; Deftereos, Spyridon ; Kargiotis, Odysseas ; Sharma, Vijay K. ; Demchuk, Andrew M. ; Saqqur, Maher ; McCabe, Dominick J.H. ; Tsivgoulis, Georgios. / Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis. In: Stroke. 2018 ; Vol. 49, No. 8. pp. 1992-1995.
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abstract = "Background and Purpose-Scarce data indicate that statin pretreatment (SP) in patients with acute cerebral ischemia because of large artery atherosclerosis may be related to lower risk of recurrent stroke because of a decreased incidence of microembolic signals (MES) during transcranial Doppler monitoring. Methods-We performed a systematic review and meta-analysis of available observational studies reporting MES presence/absence or MES burden, categorized according to SP status, in patients with acute cerebral ischemia because of symptomatic (≥50{\%}) large artery atherosclerosis. In studies with partially-published data, authors were contacted for previously unpublished information. We also performed a sensitivity analysis of studies with data on MES burden categorized according to SP status, and an additional subgroup analysis in patients receiving higher-dose SP (atorvastatin 80 mg or rosuvastatin 40 mg daily). Results-Seven eligible study protocols were identified (610 patients, 54{\%} with SP). SP was associated with a reduced risk of MES detection during transcranial Doppler monitoring (risk ratio=0.67; 95{\%} CI, 0.45-0.98), with substantial heterogeneity between studies (I2=52{\%}). In studies reporting MES burden (n=4), a significantly lower number of MES were identified in patients with compared with those without SP (mean difference=−0.92; 95{\%} CI, −1.64 to -0.19), with no evidence of heterogeneity between studies (I2=49{\%}). Subgroup analysis revealed that higher-dose SP reduced the risk of detecting MES (risk ratio=0.23; 95{\%} CI, 0.06-0.88), with no evidence of heterogeneity between studies (I2=0{\%}). Conclusions-SP seems to be associated with a lower incidence and burden of MES in patients with acute cerebral ischemia because of large artery atherosclerosis.",
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AU - Safouris, Apostolos

AU - Katsanos, Aristeidis H.

AU - Kerasnoudis, Antonios

AU - Krogias, Christos

AU - Kinsella, Justin A.

AU - Sztajzel, Roman

AU - Lambadiari, Vaia

AU - Deftereos, Spyridon

AU - Kargiotis, Odysseas

AU - Sharma, Vijay K.

AU - Demchuk, Andrew M.

AU - Saqqur, Maher

AU - McCabe, Dominick J.H.

AU - Tsivgoulis, Georgios

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N2 - Background and Purpose-Scarce data indicate that statin pretreatment (SP) in patients with acute cerebral ischemia because of large artery atherosclerosis may be related to lower risk of recurrent stroke because of a decreased incidence of microembolic signals (MES) during transcranial Doppler monitoring. Methods-We performed a systematic review and meta-analysis of available observational studies reporting MES presence/absence or MES burden, categorized according to SP status, in patients with acute cerebral ischemia because of symptomatic (≥50%) large artery atherosclerosis. In studies with partially-published data, authors were contacted for previously unpublished information. We also performed a sensitivity analysis of studies with data on MES burden categorized according to SP status, and an additional subgroup analysis in patients receiving higher-dose SP (atorvastatin 80 mg or rosuvastatin 40 mg daily). Results-Seven eligible study protocols were identified (610 patients, 54% with SP). SP was associated with a reduced risk of MES detection during transcranial Doppler monitoring (risk ratio=0.67; 95% CI, 0.45-0.98), with substantial heterogeneity between studies (I2=52%). In studies reporting MES burden (n=4), a significantly lower number of MES were identified in patients with compared with those without SP (mean difference=−0.92; 95% CI, −1.64 to -0.19), with no evidence of heterogeneity between studies (I2=49%). Subgroup analysis revealed that higher-dose SP reduced the risk of detecting MES (risk ratio=0.23; 95% CI, 0.06-0.88), with no evidence of heterogeneity between studies (I2=0%). Conclusions-SP seems to be associated with a lower incidence and burden of MES in patients with acute cerebral ischemia because of large artery atherosclerosis.

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