The effects of moderate-dose statin therapy on intracranial plaques with mild to moderate stenosis: a high-resolution MR vessel wall imaging study.

OBJECTIVE

To assess moderate-dose statin effects on intracranial plaques with < 70% stenosis using high-resolution vessel wall imaging (HR-VWI).

MATERIALS AND

METHODS

This retrospective study enrolled patients with intracranial atherosclerosis and initiating statin therapy. HR-VWI was used to evaluate the therapeutic effects of statins on two subgroups: the culprit plaques and significantly enhanced plaques. Plaque characteristics and their change rates before and after treatment were analyzed for each subgroup. Multiple linear regression analysis was used to evaluate the relationship between the effectiveness of statin therapy and baseline plaque characteristics.

RESULTS

Fifty-two patients (age 60.4 ± 11.3 years, 40 males and 12 females) with 138 plaques were enrolled. Maximum plaque thickness (p = 0.007), plaque burden (p = 0.003), luminal stenosis (p < 0.001), and plaque enhancement (p < 0.001) were significantly reduced in culprit plaques. Culprit plaques showed greater reductions in plaque burden (p = 0.009) and luminal stenosis (p = 0.028) change rates compared to non-culprit plaques. There were significant reductions in maximum plaque length (p = 0.044), maximum plaque thickness (p = 0.036), luminal stenosis (p = 0.047), and plaque enhancement (p < 0.001) in significantly enhanced plaques. The significantly enhanced plaques also demonstrated a more pronounced decrease in enhancement change rate (p = 0.037) compared to mildly enhanced plaques. Higher plaque burden (%, B = -0.28, S.E = 0.13, p = 0.036) and plaque enhancement degree (%, B = -0.16, S.E = 0.07, p = 0.015) were positively correlated with statin treatment on plaque enhancement change rate.

CONCLUSION

Compared to non-culprit plaques and plaques with mild enhancement, moderate-dose statins demonstrate superior therapeutic efficacy for culprit plaques and significantly enhanced plaques with stenosis < 70%.

KEY POINTS: Question To assess the effects of moderate-dose statin therapy on intracranial atherosclerotic plaques with mild to moderate stenosis using high-resolution vessel wall imaging. Findings Compared to non-culprit plaques and plaques with mild enhancement, moderate-dose statins demonstrate superior therapeutic efficacy for culprit plaques and significantly enhanced plaques with stenosis < 70%. Clinical relevance Early statin intervention can stabilize and regress high-risk intracranial plaques, reduce luminal narrowing, and provide effective secondary prevention for stroke and transient ischemic attack in patients with < 70% stenosis.