Could statin improve outcomes after pipeline embolization for intracranial aneurysms in a real-world setting?

Xinrui Wang; Mirzat Turhon; Xinjian Yang; Jianmin Liu; Hongqi Zhang; Tianxiao Li; Donglei Song; Yuanli Zhao; Sheng Guan; Aisha Maimaitili; Yunyan Wang; Wenfeng Feng; Jieqing Wan; Guohua Mao; Huaizhang Shi; Zhuoling An; Yang Wang

doi:10.1177/17562864231170517

Could statin improve outcomes after pipeline embolization for intracranial aneurysms in a real-world setting?

Ther Adv Neurol Disord. 2023 May 10:16:17562864231170517. doi: 10.1177/17562864231170517. eCollection 2023.

Authors

Xinrui Wang¹, Mirzat Turhon^{2

3}, Xinjian Yang^{2

3}, Jianmin Liu⁴, Hongqi Zhang⁵, Tianxiao Li⁶, Donglei Song⁷, Yuanli Zhao⁸, Sheng Guan⁹, Aisha Maimaitili¹⁰, Yunyan Wang¹¹, Wenfeng Feng¹², Jieqing Wan¹³, Guohua Mao¹⁴, Huaizhang Shi¹⁵, Zhuoling An¹⁶, Yang Wang¹⁷

Affiliations

¹ Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
² Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
³ Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.
⁴ Department of Neurosurgery, Changhai Hospital, Shanghai, People's Republic of China.
⁵ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
⁶ Department of Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China.
⁷ Department of Neurosurgery, Shanghai Donglei Brain Hospital, Shanghai, People's Republic of China.
⁸ Department of Neurosurgery, Peking University International Hospital, Beijing, People's Republic of China.
⁹ Department of Intervention Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
¹⁰ Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.
¹¹ Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, People's Republic of China.
¹² Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
¹³ Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, People's Republic of China.
¹⁴ Department of Neurosurgery, Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
¹⁵ Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
¹⁶ Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 10020, People's Republic of China.
¹⁷ Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 10020, People's Republic of China.

Abstract

Background: Several pharmacological pathways have revealed statin to have a positive role in patients with for intracranial aneurysms. However, prior studies regarding the association between statin use and patients' outcomes after pipeline embolization device (PED) treatment were not completely supportive.

Objectives: To investigate whether statin medication following PED treatment would improve the outcomes of intracranial aneurysm patients in a real-world setting.

Design: A retrospective multicenter cohort study.

Methods: Patients were selected from the PLUS registry study conducted from November 2014 to October 2019 across 14 centers in China. The population was divided into two groups: those who received statin medication after the PED treatment and those who did not receive statin medication after PED treatment. Study outcomes included angiographic evaluation of aneurysm occlusion, parent arteries stenosis, ischemic and hemorrhage complications, all-cause mortality, neurologic mortality, and functional outcome.

Results: 1087 patients with 1168 intracranial aneurysms were eligible; 232 patients were in the statin user group and the other 855 were in the non-statin user group. For the statin user group versus the non-statin user group, no significant difference was found for the primary outcomes of complete occlusion of aneurysm (82.4% versus 84.2%; p = 0.697). Of the secondary outcomes, none had a significant difference including stenosis of parent arteries ≥ 50% (1.4% versus 2.3%; p = 0.739), total subarachnoid hemorrhage (0.9% versus 2.5%; p = 0.215), all-cause mortality (0.0% versus 1.9%; p = 0.204), neurologic mortality (0.0% versus 1.6%; p = 0.280), excellent (95.5% versus 97.2%; p = 0.877), and favorable (98.9% versus 98.4%; p = 0.933) functional outcomes. The total ischemic complication rate (9.0% versus 7.1%; p = 0.401) was higher but not significant in the statin user group. The propensity score-matched cohort showed similar results. Results of binary multivariable logistic regression analysis and propensity score-matched analysis both showed that statin usage was not independently associated with an increased rate of complete occlusion or any other secondary outcomes. Subgroup analysis found the same result in patients who did not use statin before the procedure.

Conclusion: Among patients with intracranial aneurysms, statin use after the PED treatment was not significantly associated with better angiographic and clinical outcomes. Well-designed studies are needed to further confirm this finding.

Keywords: intracranial aneurysm; pipeline embolization device; statin.