This Article Full Text Full Text (PDF) All Versions of this Article: 40/5/1729    most recent STROKEAHA.108.532473v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Meier, N. Articles by Arnold, M. Search for Related Content PubMed PubMed Citation Articles by Meier, N. Articles by Arnold, M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CHOLESTEROL Medline Plus Health Information Statins Stroke Related Collections Lipids Fibrinolysis Acute Cerebral Infarction Intracerebral Hemorrhage Thrombolysis Lipid and lipoprotein metabolism

(Stroke. 2009;40:1729.)
© 2009 American Heart Association, Inc.

Original Contributions

Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke

Niklaus Meier, MD; Krassen Nedeltchev, MD; Caspar Brekenfeld, MD; Aekaterini Galimanis, MD; Urs Fischer, MD; Oliver Findling, MD; Luca Remonda, MD; Gerhard Schroth, MD; Heinrich P. Mattle, MD Marcel Arnold, MD

From the Departments of Neurology (N.M., K.N., A.G., U.F., O.F., H.P.M., M.A.) and Neuroradiology (C.B., L.R., G.S.), Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.

Correspondence to Marcel Arnold, MD, Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Freiburgstrasse 4, CH-3010 Bern, Switzerland. E-mail marcel.arnold{at}insel.ch

Background and Purpose— There are only limited data on whether prior statin use and/or cholesterol levels are associated with intracranial hemorrhage (ICH) and outcome after intra-arterial thrombolysis. The purpose of this study was to evaluate the association of statin pretreatment and cholesterol levels with the overall frequency of ICH, the frequency of symptomatic ICH, and clinical outcome at 3 months.

Methods— We analyzed 311 consecutive patients (mean age, 63 years; 43% women) who received intra-arterial thrombolysis.

Results— Statin pretreatment was present in 18%. The frequency of any ICH was 20.6% and of symptomatic ICH 4.8%. Patients with any ICH were more often taking statins (30% versus 15%, P=0.005), more often had atrial fibrillation (45% versus 30%, P=0.016), had more severe strokes (mean National Institute of Health Stroke Scale score 16.5 versus 14.7, P=0.022), and less often good collaterals (16% versus 24%, P=0.001). Patients with symptomatic ICH were more often taking statins (40% versus 15%, P=0.009) and had less often good collaterals (0% versus 24%, P<0.001). Any ICH or symptomatic ICH were not associated with cholesterol levels. After multivariate analysis, the frequency of any ICH remained independently associated with previous statin use (OR, 3.1; 95% CI, 1.53 to 6.39; P=0.004), atrial fibrillation (OR, 2.5; CI, 1.35 to 4.75; P=0.004), National Institutes of Health Stroke Scale score (OR, 1.1; CI, 1.00 to 1.10; P=0.037), and worse collaterals (OR, 1.7; CI, 1.19 to 2.42; P=0.004). There was no association of outcome with prior statin use, total cholesterol level, or low-density lipoprotein cholesterol level.

Conclusion— Prior statin use, but not cholesterol levels on admission, is associated with a higher frequency of any ICH after intra-arterial thrombolysis without impact on outcome.

Key Words: cerebral ischemia • cholesterol • hemorrhage • statins • thrombolysis