Atorvastatin Improves Outcomes, LDL-C Following Pipeline Therapy for Intracranial Aneurysms

Therapy with atorvastatin (Lipitor; Pfizer) improved outcomes in patients with intracranial aneurysms (IAs) who underwent pipeline embolization device (PED) implantation through reducing the incidence of ischemic and cerebrovascular complications, especially in patients with elevated low-density lipoprotein cholesterol (LDL-C), according to new data published by investigators in Stroke.¹

Lowering LDL-C levels could improve postoperative outcomes. | Image Credit: © Navaporn - stock.adobe.com

Relevance of LDL-C in Intracranial Aneurysms

IA is a subtype of stroke that presents with a significant mortality rate and likelihood of residual neurological complications. PEDs are a type of advanced neurointerventional device that constitute a mainstay of IA management and have been widely applied in the treatment of this population; however, complication rates remain high with PED use and represent a major area of concern for health care providers.^1-3

High LDL-C is an established risk factor for vascular events; statin therapy, with atorvastatin representing a standard option, is a first-line therapy to reduce LDL-C levels. Beyond the improvement of a patient’s cardiovascular risk, statins—often within 24 hours of initiation—provide vast therapeutic benefits that can mitigate the perioperative surgical stress that encompasses the organs. Based on these observations, statins are often administered to improve vascular surgical outcomes, although research on the influence of statins on flow-diversion treatment for IAs—such as PED—is lacking.^1,4

Because of the still-remaining controversy regarding the associations between statin treatment and post-PED outcomes, the current investigators sought to fill gaps in research by investigating the disparities, dosage, duration, and LDL-C levels of post-PED patients initiating statin therapy. Overall, the authors aimed to determine whether standard-of-care statin therapy was associated with better outcomes in this population and whether these purported effects were altered by LDL-C levels.¹

Statin Therapy Improves Outcomes Following PED Related to IA

A retrospective analysis was initiated utilizing data from a prospective, multicenter registry of patients with IAs in the Chinese population. From this data set, the authors identified those who received PED therapy between January 2018 and December 2022. Primary study outcomes included perioperative cerebrovascular complications and new-onset cerebrovascular complications during follow-up, the incidence of in-stent stenosis, and composite cerebrovascular events.¹

In total, 1193 patients (statin group: n = 603; nonstatin group: n = 590) met the eligibility criteria for enrollment. Patients treated with statins were more likely to include those who were older and with a history of diabetes and ischemia and higher baseline LDL-C levels.¹

Patients treated with statins were found to have a significantly reduced incidence of perioperative complications compared with those not treated with statins (4.0% vs 8.1%; P = .003), with a meaningful reduction in postoperative ischemia (2.2% vs 5.8%; P = .002). In the propensity-matched cohort, these beneficial effects were sustained, where statin use was linked to lower rates of perioperative complications and postoperative ischemia.¹

Complete occlusion rates were found to be comparable between the statin and nonstatin groups (81.9% vs 81.6%; P = .881). Notably, the statin group demonstrated a meaningfully lower rate of ISS (8.4% vs 14.3%; P = .001) compared with nonstatin users. For patients who participated in the clinical follow-up (n = 1190; 99.7%), there was a more favorable functional prognosis in the statin treatment group than in the nonstatin treatment group, though the difference was not significant (99.0% vs 97.3%; P = .203).¹

When stratifying the results by baseline LDL-C levels—specifically, comparing patients with LDL levels less than 2.59 mmol/L to those at or above this threshold—the authors found that the incidence of each type of perioperative complication was lower in those with lower LDL levels. A multivariable adjustment revealed that statin treatment could provide a protective effect for patients with higher baseline LDL-C levels against the development of cerebrovascular complications (odds ratio [OR] = 0.371 [95% CI, 0.195–0.705]; P = .002) and postoperative ischemia (OR = 0.239 [95% CI, 0.100–0.570]; P = .001).¹

“These findings underscore the clinical significance of statin therapy in the context of flow-diverter stent treatment and highlight its potential to improve outcomes, which provides insights for clinical decision-making,” the investigators concluded. “The implications of our study warrant further exploration through targeted clinical trials to confirm the role of statins in vascular interventional procedures.”¹

REFERENCES

1. Feng X, Huang C, Tong X, et al. Effect of LDL-Cholesterol Levels and Oral Atorvastatin on Outcomes After Pipeline Therapy for Intracranial Aneurysms. Stroke. Published Online August 6, 2025. doi:10.1161/STROKEAHA.124.04983

2. Claassen J, Park S. Spontaneous subarachnoid haemorrhage. 2022;400(10355):846-862. doi:10.1016/S0140-6736(22)00938-2

3. Brinjikiji W, Murad MH, Lanzino G, et al. Endovascular Treatment of Intracranial Aneurysms With Flow Diverters: A Meta-Analysis. Stroke. 2013;44(2). doi:10.1161/STROKEAHA.112.678151

4. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455