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Updated: Mar 25, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Statin pretreatment is associated with better outcomes in large artery atherosclerotic stroke
Georgios Tsivgoulis1, Aristeidis H Katsanos2, Vijay K Sharma2
1From the Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K., C.Z., K.Voumvourakis), Attikon University Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T., R.M., V.W.), St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K., S.G.), University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece; Division of Neurology (V.K.S.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (C.K., S.F.), St. Josef-Hospital, Ruhr University, Bochum, Germany; Neurology Department (R.M., V.W.), St. Anne's Hospital and Masaryk University, Brno, Czech Republic; Department of Neurology (K.Vadikolias), University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; Neurology Clinic (M.M.), Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia; Stroke Unit (A.S.), Department of Neurology, Brugmann University Hospital, Brussels, Belgium; Departments of Vascular Surgery (S.V.) and Neurosurgery (E.B.), Attikon University Hospital, University of Athens, Greece; and Australian Catholic University (A.W.A.), Sydney, Australia. tsivgoulisgiorg@yahoo.gr.
Objective:
Even though statin pretreatment is associated with better functional outcomes and lower risk of mortality in acute ischemic stroke, there are limited data evaluating this association in acute ischemic stroke due to large artery atherosclerosis (LAA), which carries the highest risk of early stroke recurrence.
Methods:
Consecutive patients with acute LAA were prospectively evaluated from 7 tertiary-care stroke centers during a 3-year period. Statin pretreatment, demographics, vascular risk factors, and admission and discharge stroke severity were recorded. The outcome events of interest were neurologic improvement during hospitalization (quantified as the relative decrease in NIH Stroke Scale score at discharge in comparison to hospital admission), favorable functional outcome (FFO) (defined as modified Rankin Scale score of 0-1), recurrent stroke, and death at 1 month. Statistical analyses were performed using univariable and multivariable Cox regression models adjusting for potential confounders. All analyses were repeated following propensity score matching.
Results:
Statin pretreatment was documented in 192 (37.2%) of 516 consecutive patients with LAA (mean age: 65 ± 13 years; 60.8% men; median NIH Stroke Scale score: 9 points, interquartile range: 5-18). Statin pretreatment was associated with greater neurologic improvement during hospitalization and higher rates of 30-day FFO in unmatched and matched (odds ratio for FFO: 2.44; 95% confidence interval [CI]: 1.07-5.53) analyses. It was also related to lower risk of 1-month mortality and stroke recurrence in unmatched and matched analyses (hazard ratio for recurrent stroke: 0.11, 95% CI: 0.02-0.46; hazard ratio for death: 0.24, 95% CI: 0.08-0.75).
Conclusion:
Statin pretreatment in patients with acute LAA appears to be associated with better early outcomes regarding neurologic improvement, disability, survival, and stroke recurrence.
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