Atorvastatin augments collateral formation and functional recovery after indirect revascularization in adult ischemic moyamoya disease: A randomized trial.

The present study aimed to assess whether atorvastatin enhances indirect revascularization outcomes in adult ischemic moyamoya disease (MMD). In a randomized trial, 80 adults received postoperative atorvastatin (20 mg/day, n=40) or standard care (n=40); the primary outcome was good neovascularization (Matsushima grade, Good) at 6 months. The results revealed that good neovascularization was higher with atorvastatin (65.0 vs. 37.5%; risk ratio, 1.73; P=0.014). In addition, the atorvastatin group exhibited greater improvement in cerebral blood flow (mean difference, 4.3 ml/100 g/min; P<0.001) and functional outcome (72.5 vs. 50.0% with modified Rankin Scale improvement; P=0.039). Ischemic event recurrence was also lower in the atorvastatin group (2.5 vs. 12.5%; P=0.201), whereas safety profiles were similar. In conclusion, the present single-center randomized trial provides preliminary evidence that adjunctive atorvastatin may improve collateral formation, cerebral perfusion and functional status after indirect revascularization in adult ischemic MMD. Large-scale multi-center studies are warranted to validate these findings. This trial was registered in the Chinese Clinical Trial Registry as trail no. ChiCTR1800016363, on June 3, 2018.