Statin therapy at the time of carotid angioplasty and stenting reduces procedure-related neurological complications

Background and Purpose: Treatment with 3-hydroxy-3-methyglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) reduces the incidence of myocardial injury during and after percutaneous coronary interventions. We hypothesized that statin therapy could also have a beneficial effect among patients undergoing carotid angioplasty and stenting (CAS).

Methods: We reviewed our prospective database to compare the incidence of any transient ischemic attack (TIA), minor stroke, major stroke, or death within 30 days after CAS for symptomatic carotid disease between patients with and without statin pre-treatment.

Results: The total study population consisted of 127 CAS patients without and 53 patients with statin treatment for more than 1 week before CAS. Pretreated patients were younger (67±10 vs. 70±9 years, p<0.05) and more likely to have a history of hypertension (89 vs. 72%, p<0.05), hyperlipidemia (100 vs. 34%, p<0.05), and coronary artery disease (38 vs. 18%, p<0.01). The incidence of transient ischemic attack, stroke, or death within 30 days after CAS was significantly lower among statin-treated patients (5.7%) than among those without statin pre-treatment (18.1%) (p<0.05). After adjusting for age and for all other baseline characteristics, there was still a clear trend towards lower complication rates among statin-treated patients (OR 0.3; 95% confidence interval 0.09 to 1.09; p=0.06).

Conclusions: Preprocedural statin therapy appears to reduce the incidence of TIA, stroke, or death within 30 days after CAS. Future prospective, randomized trials are warranted to further assess this potentially protective effect of statin drugs during carotid interventions.