Hong et al Dose of Statin Pretreatment in Carotid Stenting 1891 Subjects and Methods Selection of Study Patients and Data Collection

A recent randomized trial showed that periprocedural complications occurred at similar rates in carotid endarterectomy (CEA) and carotid artery stenting (CAS). However, the incidence of periprocedural complications other than myocardial infarction was higher in CAS than in CEA. Statins are used widely given their pleiotropic and cholesterol-lowering effect; these drugs reduce the incidence of stroke and of myocardial infarction in stroke patients. Statin pretreatment reduced the incidence of myocardial infarction after percutaneous coronary interventions and the risk of perioperative stroke and mortality after CEA. However, few studies have reported on whether statin use before CAS reduced periprocedural complications. In addition, no specific statin dose has been recommended in carotid interventions, unlike for acute coronary interventions; for patients undergoing percutaneous coronary interventions, high-dose statin before percutaneous coronary interventions is recommended for reducing the risk of periprocedural complications. It is also unknown whether statin pretreatment has dose-dependent effects on periprocedural complication risk in patients with CAS. Here, we investigated whether statin pretreatment is associated with a reduction of periprocedural complications and whether statin has dose-dependent effects on periprocedural complication risks in patients undergoing CAS for symptomatic carotid stenosis. Background and Purpose—We investigated whether statin pretreatment can dose dependently reduce periprocedural complications in patients undergoing carotid artery stenting because of symptomatic carotid artery stenosis. Methods—We enrolled a consecutive series of 397 symptomatic carotid artery stenosis (≥50% stenosis on conventional angiography) treated with carotid artery stenting at 2 tertiary university hospitals over a decade. Definition of periprocedural complications included any stroke, myocardial infarction, and death within 1 month after or during the procedure. Statin pretreatment was divided into 3 categories according to the atorvastatin equivalent dose: none (n=158; 39.8%), standard dose (<40 mg of atorvastatin, n=155; 39.0%), and high dose (≥40 mg; n=84; 21.2%). A multivariable logistic regression analysis with the generalized estimating equation method was used to investigate independent factors in periprocedural complications. Results—The patients’ mean age was 68.7 years (81.6% men). The periprocedural complication rates across the 3 categories of statin use were 12.0%, 4.5%, and 1.2%. After adjustment, a change in the atorvastatin dose category was associated with reduction in the odds of periprocedural complications for each change in dose category (standard-dose statin: odds ratio, 0.24; 95% confidence interval, 0.07−0.81; high-dose statin: odds ratio, 0.11; 95% confidence interval, 0.01−0.96; P for trend=0.01). Administration of antiplatelet drugs was also an independent factor in periprocedural complications (OR, 0.18; 95% CI, 0.05−0.69). Conclusions—This study shows that statin pretreatment may reduce the incidence of periprocedural complications dose dependently in patients with symptomatic carotid artery stenting. (Stroke. 2017;48:1890-1894. DOI: 10.1161/ STROKEAHA.117.016680.)