Las estatinas reducen el realce de la pared en la RM de la pared del vaso en aneurismas disecantes vertebrobasilares...

Background Vertebrobasilar dissecting aneurysms (VBDAs) are important causes of stroke. Aneurysm wall enhancement at vessel wall (VW) MRI is a marker of inflammation. Previous studies have shown that statins may reduce inflammation in intracranial saccular aneurysms, but their effect on VBDAs remains unknown. Purpose To evaluate the effect of 6-month atorvastatin treatment on VBDA wall enhancement on VW MRI scans. Materials and Methods Participants with unruptured VBDAs were enrolled in this open-label, randomized controlled trial from July 2021 to January 2023 and randomized 1:1 to the daily 20 mg atorvastatin group or control group. VBDAs were imaged with VW MRI at baseline and at the 6-month follow-up. The primary end point was the change in aneurysm wall enhancement measured by the quantitative wall enhancement index (WEI) and three-dimensional wall enhancement volume rate (WEVR). The secondary outcomes were changes in aneurysm size or morphology and inflammation-related circulating biomarkers. All outcome analyses were performed using appropriate tests for categorical and continuous variables. Results A total of 40 participants were included (mean age, 52 years ± 11 [SD]; 34 men). In the statin group, both the WEI and WEVR of the aneurysm wall decreased at 6 months compared with those at baseline. The change in WEI was -0.3 in the statin group but 0.1 in the control group (P < .001). Similarly, the change in WEVR was -15.1% in the statin group but 5.3% in the control group (P < .001). Additionally, the circulating plasma levels of C-reactive protein, tumor necrosis factor α, interleukin-6, and interleukin-1β improved in the atorvastatin group compared with the control group (all P < .05). The atorvastatin group also showed slowed progression of intramural hematoma (304.0 mm³ vs 100.3 mm³; P = .006). No change in aneurysm size was detected in both groups. Conclusion Atorvastatin use decreased VBDA wall enhancement on VW MRI scans compared with the control group. ClinicalTrials.gov Identifier: NCT04943783 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Mohajer and Chernyak in this issue.