W Brinjikji1, H Cloft2, S Cekirge3, D Fiorella4, R A Hanel5, P Jabbour6, P Lylyk7, C McDougall8, C Moran9, A Siddiqui10, I Szikora11, D F Kallmes2. 1. From the Department of Radiology (W.B., H.C., D.F.K.), Mayo Clinic, Rochester, Minnesota brinjikji.waleed@mayo.edu. 2. From the Department of Radiology (W.B., H.C., D.F.K.), Mayo Clinic, Rochester, Minnesota. 3. Department of Radiology (S.C.), Koru Hospital and Bayindir Hospitals, Ankara, Turkey. 4. Department of Neurosurgery (D.F.), Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York. 5. Stroke and Cerebrovascular Surgery (R.A.H.), Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, Florida. 6. Department of Neurosurgery (P.J.), Thomas Jefferson University, Philadelphia, Pennsylvania. 7. Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular y Radiología Intervencionista de Buenos Aires-Clinica La Sagrada Familia, Buenos Aires, Argentina. 8. Department of Endovascular Neurosurgery (C.McDougall), Barrow Neurological Institute, Phoenix, Arizona. 9. Division of Interventional Neuroradiology (C.Moran), Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri. 10. Department of Neurosurgery (A.S.), University at Buffalo Neurosurgery, Buffalo, New York. 11. Department of Neurointerventional Services (I.S.), National Institute of Clinical Neurosciences, Budapest, Hungary.
Abstract
BACKGROUND AND PURPOSE: Use of statin medications has been demonstrated to improve clinical and angiographic outcomes in patients receiving endovascular stent placement for coronary, peripheral, carotid, and intracranial stenoses. We studied the impact of statin use on long-term angiographic and clinical outcomes after flow-diverter treatment of intracranial aneurysms. MATERIALS AND METHODS: We performed a post hoc analysis from pooled patient-level datasets from 3 Pipeline Embolization Device studies: the International Retrospective Study of the Pipeline Embolization Device, the Pipeline for Uncoilable or Failed Aneurysms Study, and the Aneurysm Study of Pipeline in an Observational Registry. We analyzed data comparing 2 subgroups: 1) patients on statin medication, and 2) patients not on statin medication at the time of the procedure and follow-up. Angiographic and clinical outcomes were compared by using the χ2 test, Fisher exact test, or Wilcoxon rank sum test. RESULTS: We studied 1092 patients with 1221 aneurysms. At baseline, 226 patients were on statin medications and 866 patients were not on statin medications. The mean length of clinical and angiographic follow-up was 22.1 ± 15.1 months and 28.3 ± 23.7 months, respectively. There were no differences observed in angiographic outcomes at any time point between groups. Rates of complete occlusion were 82.8% (24/29) versus 86.4% (70/81) at 1-year (P = .759) and 93.3% (14/15) versus 95.7% (45/47) at 5-year (P = 1.000) follow-up for statin-versus-nonstatin-use groups, respectively. There were no differences in any complication rates between groups, including major morbidity and neurologic mortality (7.5% versus 7.1%, P = .77). CONCLUSIONS: Our study found no association between statin use and angiographic or clinical outcomes among patients treated with the Pipeline Embolization Device.
BACKGROUND AND PURPOSE: Use of statin medications has been demonstrated to improve clinical and angiographic outcomes in patients receiving endovascular stent placement for coronary, peripheral, carotid, and intracranial stenoses. We studied the impact of statin use on long-term angiographic and clinical outcomes after flow-diverter treatment of intracranial aneurysms. MATERIALS AND METHODS: We performed a post hoc analysis from pooled patient-level datasets from 3 Pipeline Embolization Device studies: the International Retrospective Study of the Pipeline Embolization Device, the Pipeline for Uncoilable or Failed Aneurysms Study, and the Aneurysm Study of Pipeline in an Observational Registry. We analyzed data comparing 2 subgroups: 1) patients on statin medication, and 2) patients not on statin medication at the time of the procedure and follow-up. Angiographic and clinical outcomes were compared by using the χ2 test, Fisher exact test, or Wilcoxon rank sum test. RESULTS: We studied 1092 patients with 1221 aneurysms. At baseline, 226 patients were on statin medications and 866 patients were not on statin medications. The mean length of clinical and angiographic follow-up was 22.1 ± 15.1 months and 28.3 ± 23.7 months, respectively. There were no differences observed in angiographic outcomes at any time point between groups. Rates of complete occlusion were 82.8% (24/29) versus 86.4% (70/81) at 1-year (P = .759) and 93.3% (14/15) versus 95.7% (45/47) at 5-year (P = 1.000) follow-up for statin-versus-nonstatin-use groups, respectively. There were no differences in any complication rates between groups, including major morbidity and neurologic mortality (7.5% versus 7.1%, P = .77). CONCLUSIONS: Our study found no association between statin use and angiographic or clinical outcomes among patients treated with the Pipeline Embolization Device.
Authors: Gabriel A Quiñones-Ossa; Carolina Lobo; Ezequiel Garcia-Ballestas; William A Florez; Luis Rafael Moscote-Salazar; Amit Agrawal Journal: Neurointervention Date: 2021-01-04