Prior statin use, intracranial hemorrhage, and outcome after intra-arterial thrombolysis for acute ischemic stroke.
OBJECTIVE
There are only limited data on whether prior statin use and/or cholesterol levels are associated with intracranial hemorrhage (ICH) and outcome after intra-arterial thrombolysis. The purpose of this study was to evaluate the association of statin pretreatment and cholesterol levels with the overall frequency of ICH, the frequency of symptomatic ICH, and clinical outcome at 3 months.


METHODS
We analyzed 311 consecutive patients (mean age, 63 years; 43% women) who received intra-arterial thrombolysis.


RESULTS
Statin pretreatment was present in 18%. The frequency of any ICH was 20.6% and of symptomatic ICH 4.8%. Patients with any ICH were more often taking statins (30% versus 15%, P=0.005), more often had atrial fibrillation (45% versus 30%, P=0.016), had more severe strokes (mean National Institute of Health Stroke Scale score 16.5 versus 14.7, P=0.022), and less often good collaterals (16% versus 24%, P=0.001). Patients with symptomatic ICH were more often taking statins (40% versus 15%, P=0.009) and had less often good collaterals (0% versus 24%, P<0.001). Any ICH or symptomatic ICH were not associated with cholesterol levels. After multivariate analysis, the frequency of any ICH remained independently associated with previous statin use (OR, 3.1; 95% CI, 1.53 to 6.39; P=0.004), atrial fibrillation (OR, 2.5; CI, 1.35 to 4.75; P=0.004), National Institutes of Health Stroke Scale score (OR, 1.1; CI, 1.00 to 1.10; P=0.037), and worse collaterals (OR, 1.7; CI, 1.19 to 2.42; P=0.004). There was no association of outcome with prior statin use, total cholesterol level, or low-density lipoprotein cholesterol level.


CONCLUSIONS
Prior statin use, but not cholesterol levels on admission, is associated with a higher frequency of any ICH after intra-arterial thrombolysis without impact on outcome.
Meier
Niklaus
N
Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Nedeltchev
Krassen
K
Brekenfeld
Caspar
C
Galimanis
Aekaterini
A
Fischer
Urs
U
Findling
Oliver
O
Remonda
Luca
L
Schroth
Gerhard
G
Mattle
Heinrich P
HP
Arnold
Marcel
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000473:pathology*; D002784:Cholesterol / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol