The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

S Andersen; E Western; W Sorteberg; A Sorteberg

doi:10.1007/s00701-023-05812-2

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

Acta Neurochir (Wien). 2023 Nov;165(11):3325-3338. doi: 10.1007/s00701-023-05812-2. Epub 2023 Oct 4.

Authors

S Andersen¹, E Western², W Sorteberg³, A Sorteberg^{4

5}

Affiliations

¹ Institute of Clinical Medicine, University of Oslo, P.B. 1072, 0316, Blindern, Oslo, Norway.
² Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, P.B. 4950, 0424, Oslo, Norway.
³ Department of Neurosurgery, Oslo University Hospital, Nydalen, P.B. 0454, 0424, Oslo, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, P.B. 1072, 0316, Blindern, Oslo, Norway. asortebe@ous-hf.no.
⁵ Department of Neurosurgery, Oslo University Hospital, Nydalen, P.B. 0454, 0424, Oslo, Norway. asortebe@ous-hf.no.

Abstract

Background: Pleiotropic effects of statins may be beneficial in alleviating cerebral vasospasm (VS) and improving outcome after aneurysmal subarachnoid hemorrhage (aSAH). Initiation of statin treatment at aSAH is not recommended; however, the effect of pre-ictal and continued statin use is not fully investigated.

Methods: Retrospective study comparing aSAH patients admitted in 2012 to 2021 with pre-ictal statin use versus those not using statins. Patient entry variables, radiological/sonological VS, symptomatic VS, and radiologically documented delayed cerebral ischemia (DCI) were registered. Outcome was scored in terms of mortality, modified Rankin score, Glasgow outcome score extended, and levels of fatigue. Patients were compared on group level and in a case-control design.

Results: We included 961 patients, with 204 (21.2%) statin users. Statin users were older and had more often hypertension. Severe radiological/sonological VS, symptomatic VS, and DCI were less frequent in statin users, and their length of stay was shorter. Mortality, functional outcome, and levels of fatigue were similar in both groups. When analyzing 89 pairs of statin users and non-statin users matched for age, aSAH severity, gender, and hypertension, we confirmed decreased radiological/sonological and symptomatic VS as well as shorter length of stay in statin users. They also had more often a favorable functional outcome and lower levels of fatigue.

Conclusions: Patients with pre-ictal and continued use of statins have a reduced occurrence of radiological/sonological and symptomatic VS, shorter length of stay, and more often favorable functional outcome, whereas mortality is similar to non-statin users. Even though larger multicenter studies with common, strict protocols for prevention, diagnosis, and treatment of vasospasm are needed to finally establish the value of statins in aSAH, continuation of pre-ictal statin use seems worthwhile.

Keywords: Aneurismal subarachnoid hemorrhage; Fatigue; Outcome; Statins; Vasospasm.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / epidemiology
Cerebral Infarction / epidemiology
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Hypertension*
Retrospective Studies
Subarachnoid Hemorrhage* / complications
Subarachnoid Hemorrhage* / diagnosis
Subarachnoid Hemorrhage* / drug therapy
Vasospasm, Intracranial* / diagnostic imaging
Vasospasm, Intracranial* / drug therapy
Vasospasm, Intracranial* / etiology

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors