Use of Statin Therapy Improves Outcomes after Carotid Interventions
Zoler, Mitchel L., Clinical Psychiatry News
HOLLYWOOD, FLA. -- Statin use has been linked with reducing stroke rates and mortality following carotid endarterectomy and may have a similar benefit in patients undergoing carotid artery stenting, Dr. Bruce A. Perler said at ISET2008.
Statin treatment "can make carotid endarterectomy, which is already a terrific operation, even better, and my sense is that it may also improve the outcomes of carotid artery stenting as well," said Dr. Perler during an international symposium on endovascular therapy.
He based these conclusions on a series of findings on statins collected over several years that dealt with both the clinical effects of statin treatment and the impact of statin treatment in both randomized, controlled studies and reviews of observational data. Among the unresolved questions mentioned by Dr. Perler are:
* How long does the patient need to have been on statin therapy before carotid intervention to experience a benefit?
* What is the impact of temporarily stopping statin treatment during surgery?
* Which specific statin, formulation, and dosage have optimal effects?
Because treatment with an oral statin may have to stop for at least a day during and immediately after surgery, the best formulation to use before surgery may be an extended-release statin.
One of the most compelling demonstrations of the power of statin treatment was in an analysis from Dr. Perler and his associates that they first reported in 2005. They reviewed their experience performing carotid endarterectomy on 1,566 patients during 1994-2004. The average age of the patients was 72, 63% were men, 42% were symptomatic, and 657 (42%) were on a statin at the time of their surgery.
During the first 30 days after surgery, the patients who had been on a statin had a significantly reduced rate of stroke and death, compared with the patients who had not received a statin. …