CAS enhances statin effects on contralateral plaque stability in bilateral carotid stenosis
MedWire News: Ipsilateral carotid artery stenting (CAS) combined with intensive atorvastatin therapy is associated with enhanced contralateral plaque stability compared with atorvastatin therapy alone in patients with bilateral carotid stenosis, a Greek study has found.
The combined therapy also attenuated inflammatory burden and calcification inhibitors to a greater extent that lipid-lowering therapy alone, the researchers note. N Kadoglou, from the Hippokratio General Hospital of Thessaloniki, and colleagues investigated whether unilateral carotid revascularization could beneficially influence serum cardiovascular biomarkers and/or the natural history of contralateral carotid plaques.
They assessed changes in osteopontin (OPN), osteoprotegerin (OPG) and the Gray-Scale Median (GSM) score contralateral to symptomatic carotid stenosis.
In all, 113 bilateral carotid stenosis patients took part in the study. These patients were divided into two groups: group A comprised 46 patients with significant carotid stenosis (North American Symptomatic Carotid Endarterectomy [NASCE] >70%) who underwent ipsilateral CAS, and group B comprised 67 patients with low-grade bilateral carotid stenosis (NASCET 30–69%) and no indications for revascularization.
All the patients received atorvastatin (10–80 mg) treatment for 6 months to achieve a target low-density lipoprotein (LDL) level below 100 mg/dl. Blood samples and plaques’ GSM score contralateral to brain infarct were assayed at baseline and after 6 months.
Atorvastatin treatment significantly improved lipid profiles in both groups to a similar extent.
The researchers note, however, that patients in group A experienced significantly greater reductions in levels of high-sensitivity C-reactive protein, OPN and OPG compared to patients in group B, with differences of around 2 mg/l, 20 ng/ml, and 2 pmolar, respectively. Both groups had significantly improved contralateral GSM score following treatment, but this improvement was significantly greater in patients in group A compared with those in group B, by just under 20 points.
This increment in GSM score was inversely correlated with the reductions in OPN, OPG, and low-density lipoprotein levels.
Writing in the European Journal of Vascular and Endovascular Surgery, the researchers conclude: “Patients with significant ipsilateral carotid stenosis greatly profited from combined treatment with CAS and statin in terms of cardiovascular risk profile and contralateral plaque stability.”
They suggest: “Prospective studies will determine whether the degree of carotid stenosis is an adequately valid criterion for carotid revascularization in symptomatic patients.”
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By Joel Levy