The effect of statin use on embolic potential during carotid angioplasty and stenting

Statin use results in atherosclerotic plaque stabilization. We sought to determine the effects of statins on the size and number of embolic particles generated during carotid artery stenting (CAS).

Embolic debris from carotid filters following CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, pre-operative cerebrovascular symptoms, statin use, and outcomes (peri-operative major adverse events, MAE) were reviewed.

Carotid filters from 62 consecutive CAS procedures were examined. The mean age is 68.7 ± 9.8 years, 64% were men, 41 (66%) were on statins at the time of CAS, and 27 (43.5%) had neurological symptoms pre-procedurally. The mean intra-procedural stenosis was similar between groups (statin: 89.4 ± 7.4% vs. no statin: 88.4 ± 5.9%, P = NS). There was no significant difference in overall pre-operative symptoms between the two groups. Statin users were more likely to have coronary artery disease (CAD, P = 0.02), hyperlipidemia (HL, P = 0.047), or have undergone coronary artery bypass (CABG, P = 0.01). Statin use was associated with significantly less embolic particles (statin: 16.4 ± 2.1 vs. no statin: 42.4 ± 9.5, P = 0.001) during CAS. Further, multivariate analysis controlling for CAD, HL, and CABG confirmed that statin use was independently associated with less captured debris (P = 0.005). There was no significant difference in the mean particle size (statin: 326.2 μm ± 31.1 vs. no statin 310.5 μm ± 41.8), peri-procedural stroke, and MAE between the two groups (P = NS).

Statin use is associated with less embolic debris during CAS. Further investigation utilizing a larger study group is necessary to assess the impact of statin use on peri-procedural outcomes.