Effect of LDL-Cholesterol Levels and Oral Atorvastatin on Outcomes After Pipeline Therapy for Intracranial Aneurysms

We aimed to determine the effects of statin treatment on outcomes of pipeline embolization device therapy for intracranial aneurysms in relation to LDL (low-density lipoprotein) cholesterol levels.

Using data from the SESIA registry (Safety and Efficacy of Stent Deployment for Intracranial Aneurysms), we enrolled participants who underwent pipeline embolization device implantation at 4 centers in China (2018-2022). Statin users (atorvastatin 20 mg daily, for ≥3 days and ≥6 months preprocedurally and postprocedurally, respectively) were matched with nonstatin users (1:1) using propensity scores and further adjusted by inverse probability of treatment weighting, balancing for baseline characteristics, procedural details, and lipid levels (based on East Asian profiles). Study outcomes include perioperative complications, aneurysmal occlusion, in-stent stenosis, and clinical prognosis at the latest follow-up. Multivariable analyses using logistic and Cox regression models adjusted for these factors in both prematched and postmatched cohorts, evaluating the role of lipid modification in subgroups.

Of the 1558 patients screened, 1193 (53.75±11.07 years, 69.4% females; statin: n=603, nonstatin: n=590) were enrolled with 3- to 48-month follow-up. In the matched cohort (352 pairs), statin treatment reduced the incidences of perioperative cerebrovascular (2.0% versus 8.5%, P=0.001) and follow-up ischemic (1.7% versus 5.1%, P=0.020) complications. Multivariable analyses in participants with baseline LDL-cholesterol ≥2.59 mmol/L showed that statin treatment was associated with fewer perioperative cerebrovascular complications (odds ratio, 0.371 [95% CI, 0.195-0.705]; P=0.002), in-stent stenosis (hazard ratio, 0.433 [95% CI, 0.269-0.698]; P=0.001), and follow-up ischemic events (hazard ratio, 0.315 [95% CI, 0.135-0.733]; P=0.007; P values for interaction were 0.671, 0.009, and 0.507, respectively, versus <2.59 mmol/L). Postmatched analyses confirmed consistency for perioperative cerebrovascular complications (odds ratio, 0.416 [95% CI, 0.211-0.821]), in-stent stenosis (hazard ratio, 0.397 [95% CI, 0.232-0.667]), and follow-up ischemic events (hazard ratio, 0.364 [95% CI, 0.148-0.895]).

Atorvastatin treatment improved postpipeline embolization device-deployment outcomes by reducing ischemic events, particularly in patients with elevated LDL-cholesterol. The long-term benefits of adjunctive statin use in this population warrant further investigation.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03387995.