Huijuan Miao1, Yujiao Yang2, Han Wang3, Linyu Huo4, Mengnan Wang1, Yinghua Zhou5, Yang Hua5, Ming Ren1, Changhong Ren6, Xunming Ji7, Qi Yang8, Xiuhai Guo1,*
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China 2Department of Neurology, Sanbo Brain Hospital, Beijing, China 3Department of Neurology, Huimin Hospital, Beijing, China 4Department of Neurology, Haidian Hospital, Beijing, China 5Department of Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China 6Laboratory of Hypoxia, Xuanwu Hospital, Capital Medical University, Beijing, China 7Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China 8Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
Statins have proven to exert protective effects in patients with symptomatic intracranial atherosclerotic stenosis (SICAS). It is unclear whether intensive lipid-lowering therapy (ILLT) can ameliorate atherosclerosis in asymptomatic ICAS (AICAS). A single-center, prospective cohort study was performed in 71 AICAS patients with lipid-lowering therapy. Vascular stenoses were evaluated with transcranial color-coded sonography (TCCS) before and after statin treatment. With target therapeutic level of low-density lipoprotein cholesterol (LDL-C) ≤ 1.8 mmol/L or ≥ 50% reduction from baseline after the two years of follow-up, patients were divided into intensive statin treatment (IST) group and standard statin treatment (SST) group. A total of 104 stenotic intracranial arteries were detected in 51 patients belonging to the IST group and 47 arteries in 20 patients of the SST group. In the first year, LDL-C levels were significantly decreased in the IST compared with SST groups (1.48 ± 0.26 vs. 2.20 ± 0.58, P=0.000). However, the ratio of regressed ICAS in IST was not significantly higher than that in SST (26.3% vs. 5.9%, P=0.052). Forty-nine branches in 25 patients of the IST group and 16 branches in 7 patients of the SST group were followed up for two years. The LDL-C level was decreased in the IST compared with SST groups (1.55 ± 0.29 vs. 2.36 ± 0.77, P=0.048). The ratio of regressed ICAS in the IST group was significantly higher than that in SST group (34.7% vs. 6.3%, P=0.017). We concluded that the degree of stenosis in AICAS can be ameliorated with intensive lipid-lowering therapy within two years; target LDL-C level can be reached by moderate-intensity statin treatment for Chinese AICAS patients.
Table 1 Baseline characteristics of IST and SST group.
Location of stenosis, n (%)
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Degree of stenosis, n (%)
Table 2 Location and severity of AICAS (baseline TCCS results).
2.51 ± 1.00
2.63 ± 0.59
1.48 ± 0.26
2.20 ± 0.58
1.55 ± 0.29
2.36 ± 0.77
Table 3 LDL-C levels at different follow-up years.
Table 4 Changes in stenoses between IST and SST in the first and second year of follow-up.
Figure 2. A 33-year-old man with asymptomatic intracranial atherosclerosis (AICAS) in the intensive statin treatment group (IST). A and B) TCCS at one-year follow-up showed a peak systolic velocity (PSV) of 258 cm/s for the right proximal middle cerebral artery (MCA), which indicated severe stenosis (arrow). C and D) after two years of lipid-lowering treatment of Rosuvastatin (10 mg/day), follow-up TCCS showed an obvious reduction of PSV to 195 cm/s, indicating moderate stenosis (arrow).
Figure 3. Follow-up results of stenotic vessels in the IST and SST groups in the first and second year. The regression rate in the IST group was significantly higher than that in the SST group (*p=0.017).
Table 5 The changes of different stenotic levels in the first and second year of follow-up.
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