Background: Intracranial atherosclerotic stenosis(ICAS) is an independent risk factor for ischemic stroke, especially in Asians and Africans. Studies showed that statins stabilized or ameliorated atherosclerotic coronary artery and symptomatic ICAS. Effect of intensive lipid-lowering therapy (ILLT) for asymptomatic ICAS (AICAS) has not been reported.
Objective To explore whether ILLT can ameliorate the atherosclerosis of AICAS.
Method: Single-center, prospective cohort study was performed in AICAS patients, who were evaluated with transcranial doppler sonography before and after statin therapy. With target level of low density lipoprotein (LDL-C ≤ 1.8mmol/l or LDL-C decreased over 50%), patients were divided into intensive statin treatment group (IST) and standard statin treatment group (SST).
Results: (1) No statistical differences were detected in age, gender, BMI, history of HT, DM or CHD, ICAS degree between two groups. (2) 50 cases with 105 branches of AICAS in IST and 20 cases with 47 branches of AICAS in SST were followed up for 12 months. LDL-C level significantly decreased in IST (1.48 ± 0.23 vs 2.39 ± 0.65, P=0.000). In IST, 36 (36/105) AICAS regressed, 59 (59/105) was stable and 10 (10/105) progressed. In SST, 9 (9/47) ICAS regressed, 36 (36/47) ICAS was stable, and 2 (2/47) ICAS progressed. The ratio of regressed ICAS in IST was not statistically higher than that in SST (34.3% vs 19.1% P=0.059). (3) 23 cases with 48 branches of AICAS in IST and 10 cases with 22 branches of AICAS in SST were followed up for 24 months. In IST, 21 (21/48) AICAS regressed, 20 (20/48) was stable and 7 (7/48) ICAS progressed. In SST, 2 (2/22) ICAS regressed, 17(17/22) ICAS were stable and 3 (3/22) ICAS progressed. The ratio of regressed ICAS in IST was significantly higher than that in SST (43.8% vs 9.1% P=0.006).
Conclusions: (1) Degree of atherosclerosis in AICAS is further reduced with ILLT; (2) LDL-C ≤1.8mmol/l or LDL-C decreased over 50% can be reached by moderate-intensity statin for Chinese.