Impact of pretreatment and early treatment with statins on safety and efficacy outcomes in patients after acute ischemic stroke undergoing endovascular thrombectomy: a systematic review and meta-analysis.

Abstract

Introduction: It remains unclear whether early statin treatment and statin pre-treatment could change prognosis in patients after ischemic stroke undergoing endovascular thrombectomy (EVT).

Objectives: This study aims to assess whether both statins pretreatment and early statins in-hospital treatment impact the outcomes of patients with acute ischemic stroke (AIS) undergoing EVT.

Methods: We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to June 2024. The early statin use was defined as in-hospital administration of statins post-stroke onset. The statin pre-treatment was defined as the regular use of statins because of any previous indication. The efficacy outcomes were favorable functional outcomes at 90 days, reduced neurological deterioration, and NIHSS improvement greater or equal to 4 points from baseline. We defined a favorable functional outcome as a mRS of 0-2 points. The safety outcomes included symptomatic intracranial hemorrhage (sICH), any ICH, and all-cause death. All statistical analyses were performed using R version 4.4.0.

Results: Seven observational studies comprising 2,440 patients were included. The incidence of favorable functional outcomes (mRS 0-2) in 90 days(RR 1.74; 95% CI 1.38-2.20; p < 0.001; I² = 52.4%) was significantly increased in the early statins group compared with the non-statins group. In addition, sICH (RR 0.48; 95% CI 0.29-0.80; p = 0.005; I² = 45.2%), any ICH (RR 0.65; 95% CI 0.52-0.81; p < 0.001; I² = 0.0%), neurological deterioration (RR 0.36; 95% CI 0.26-0.49; p < 0.001; I² = 0%), and death in 90 days (RR 0.38; 95% CI 0.28-0.53; p < 0.001; I² = 15%) was significantly lower in the early statins group compared with the non-statins group. No difference between groups in neurological improvement was identified (RR 1.32; 95% CI 0.98-1.78; p = 0.065; I² = 66%). In the statins pre-treatment analysis there was no difference between groups in the incidence of successful recanalization (OR 2.62; 95% CI 0.80-8.53; p = 0.11; I² = 69%), the incidence of favorable functional outcomes (mRS 0-2) in 90 days (OR 1.53; 95% CI 0.82-2.83; p = 0.18; I² = 35%) and neurological improvement (OR 1.35; 95% CI 0.69-2.65; p = 0.38; I² = 0%).

Conclusion: This systematic review and meta-analysis identified that early statin treatment is correlated with significant improvement in efficacy and safety outcomes of endovascular thrombectomy. On the other hand, statins pretreatment had no considerable positive impact on outcomes of endovascular thrombectomy.. Large randomized controlled trials are needed to confirm our findings.