Improvement of exhausted cerebral vasoreactivity in carotid occlusion: benefit of statins?

Abstract

In internal carotid artery occlusion (ICAO), a spontaneous increase of cerebral vasoreactivity (CVR) may occur over time. Statins are known to increase CVR. We analyzed the influence of statin treatment and other cofactors on CVR improvement in patients with ICAO. Sixty-six patients with ICAO were reexamined after 15 ± 6 months. CVR in both middle cerebral arteries was assessed by transcranial Doppler and inhalation of 7% CO(2). Pre-defined cut-off values were used to define exhausted CVR. Cofactors analyzed were: age, sex, hypertension, diabetes, statin treatment, degree of contralateral stenosis, quality of intracranial collateral flow, duration of ICAO. Mean CVR did not differ between the two studies. Twenty patients had exhausted CVR at baseline, 11 of them improved above the cut-off at follow-up (55%). Factors significantly associated with this improvement were good collateral pattern at baseline (p = 0.0065) and statin treatment (p = 0.0179). Odds ratios for improving CVR were 36.0 [95% CI 2.7-476.3] for good collateral flow and 20.0 [95% CI 1.7-238.6] for statin treatment. In conclusion, exhausted CVR frequently improves during the course of ICAO. Good collateral function and statin treatment are significantly associated with improving CVR.

Effect of drug interventions on cerebral hemodynamics in ischemic stroke patients

“…28 The effects of statins on cerebral hemodynamics and CA in human studies has previously been reviewed and summarised by Giannopoulos et al 29 Chronic statin therapy improved cerebrovascular function in eight out of ten clinical studies. For studies in patients with cerebrovascular disease there was one study with improvement in CBF 30 and four studies that demonstrated improvements in CVR, [31][32][33][34] whilst some did not improve CBF 35 or CVR. 36 Interestingly, the cerebrovascular effects of statin appeared to be greater in patients who likely have impaired vasomotor reactivity.…”

Progress in cerebrovascular disease research in the last year

“…An increase in CVR has been described after statin treatment in patients with small vessel disease but is unclear if this effect is also seen in patients with internal carotid artery occlusions (ICAO). Reinhard et al [14] investigated the presence of spontaneous improvement of an exhausted CVR in patients with ICAO and the potential influence of statin treatment and other cofactors on this phenomenon. They analyzed data from 66 patients included in a prospective observational cohort study on cerebral hemodynamics in severe carotid artery stenosis and occlusion.…”