Abstract T MP97: Efficacy of Poststroke Intensive Rosuvastatin Treatment for Aortogenic Embolic Stroke: Episteme Trial
Background: Large atheromatous aortic plaques (AAPs) are associated with stroke recurrence. Rosuvastatin is a potent lipid-lowering agent and repress atherosclerosis. Whether rosuvastatin has anti-atherogenic effect for AAPs in stroke patients has been unclear. We performed repeated transesophageal echocardiography (TEE) examinations and analyzed the changes of AAPs after rosuvastatin treatment in stroke patients.
Methods: This trial is prospective randomized open label study. Inclusion patients were acute ischemic stroke with hypercholesterolemia and AAPs ≥4 mm in thickness on TEE. The patients are randomly assigned to either a group treated with 5 mg/day rosuvastatin or a control group. Primary endpoint is the changes in volume and composition of AAPs after 6 months using TEE. Biochemical findings are analyzed. By using repeated TEE and binary image analysis, we compared the dynamic changes in plaque composition of AAPs before and after therapy in the two groups.
Results: 102 patients were undergoing TEE, and 23 had AAPs greater than 4 mm in thickness. Of them, 16 patients (age, 68±9 years; 16 male) with acute ischemic stroke were undergoing repeated TEE and enrolled to the study. The rosuvastatin-treated and control groups had 9 and 7 patients, and 16 and 16 AAPs ≥4mm, respectively. In the rosuvastatin-treated group, the changes in low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), and LDL-C/HDL-C ratio from baseline to end of follow-up were -42.7±10.2%, -38.5±11.1%, and -41.9±8.9%, respectively, which reached significant differences compared to the control (P<0.05). In repeated TEE, there was no significant difference in changes of plaque size among two groups. Rosuvastatin significantly increased high-echoic plaques area from baseline to end of follow-up, whereas the control group showed decrease in high-echoic plaques area (58.2±63.7 vs –14.3±31.5, P<0.001).
Conclusions: Rosuvastatin improved lipid profiles, and exerted robust morphological change of AAPs from lipid-rich to fibrous content. The EPISTEME trial provided an evidence for a therapeutic strategy for aortogenic brain embolism.
Author Disclosures: Y. Ueno: None. K. Yamashiro: None. Y. Tanaka: None. M. Watanabe: None. Y. Shimada: None. T. Kuroki: None. N. Miyamoto: None. M. Daimon: None. R. Tanaka: None. K. Miyauchi: Honoraria; Modest; AstraZeneca K.K., and Shionogi Co., Ltd.. Other; Modest; an advisory member of AstraZeneca K.K. and Shionogi Co., Ltd. H. Daida: Research Grant; Significant; AstraZeneca K.K., and Shionogi Co., Ltd. Honoraria; Modest; AstraZeneca K.K., and Shionogi Co., Ltd. Other; Modest; an advisory member of AstraZeneca K.K. and Shionogi Co., Ltd.. N. Hattori: None. T. Urabe: Research Grant; Significant; AstraZeneca K.K., and Shionogi Co., Ltd. Honoraria; Modest; AstraZeneca K.K., and Shionogi Co., Ltd.
- © 2014 by American Heart Association, Inc.