title: Rosuvastatin may stabilize atherosclerotic aortic plaque: transesophageal echocardiographic study in the EPISTEME trial.
abstract: OBJECTIVE
  Large atheromatous aortic plaques (AAPs) have been associated with ischemic stroke. There is little evidence to guide the therapeutic strategy for ischemic stroke associated with large AAPs. This study sought to analyze the temporal profile of AAPs after rosuvastatin therapy in Japanese patients with acute ischemic stroke.
  
  
  METHODS
  The Efficacy of Post-stroke Intensive Rosuvastatin Treatment for aortogenic Embolic stroke (EPISTEME) trial was a prospective, randomized, open-label study. Acute ischemic stroke patients with dyslipidemia and AAPs ≥4-mm-thick on transesophageal echocardiography (TEE) were enrolled and randomly allocated to either the group treated with 5 mg/day rosuvastatin or the control group. The primary endpoint was the changes in volume and composition of AAPs on repeat TEE after 6 months. High-echoic plaque area was analyzed using binary images.
  
  
  RESULTS
  A total of 24 Japanese patients (rosuvastatin 12; control 12) were included in the primary analysis. Rosuvastatin substantially reduced low-density lipoprotein cholesterol (LDL-C) compared to control (-42.1% vs. 1.4%, P < 0.001). Percent changes of high-echoic plaque areas were significantly increased in the rosuvastatin group, while they were decreased in the control group (65.8% vs -14.7%, P < 0.001). There was a significant linear correlation between percent increase in high-echoic plaque area and LDL-C decrease (r=-0.434, P=0.002).
  
  
  CONCLUSIONS
  Treatment with 5-mg rosuvastatin for 6 months might induce atheromatous aortic plaque stabilization together with marked LDL-C reduction in Japanese patients with ischemic stroke, which could provide evidence on which to base the therapeutic strategy for aortogenic brain embolism.
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Japan; Department of Neurology, Juntendo University School of Medicine, Japan. Electronic address: yuji-u@juntendo.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamashiro
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Miyamoto
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kuroki
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000378:metabolism; D001018:Aortic Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium
keywords: Aortogenic brain embolism; Atheromatous aortic plaque; Rosuvastatin; Stroke; Transesophageal echocardiography