| Background: Atherosclerotic intracranial artery stenosis and extracranial carotidartery stenosis are the important cause of ischemic stroke and have a high rate ofstroke recurrence. Of the ischemic stroke patients in china, patients with intracranialartery stenosis， especially the middle cerebral artery stenosis (MCAS)， weresignificantly more than those with cranial arteries stenosis[1]. Statins have confirmedthat have a stable or even reverse atherosclerosis effect in a number of studies, andcan reduce the risk of stroke. The ischemic stroke primary and secondary preventionguidelines[2,3]have pointed out that high-risk cerebravascular disease and cerebralatherosclerosis patients should be prescribed statin treatment to reduce the level ofLDL-C less than2.07mmol/l. In recent years the small sample study[4,5]haveconfirmed that statins can improve intracranial artery stenosis.However, the effect ofstatins therapy on different degree MCA and the correlation between the improvementof intracranial artery stenosis and LDL-C levels have rarely been reported up to date.Objective: The purpose of our study was to determine whether different doses ofstatins stabilize or reverse the middle cerebral artery stenosis and the effect ofprevention on ischemic stroke and statins therapy on different degree MCA, and thecorrelation between the improvement of intracranial artery stenosis and LDL-C levels,and also to evaluate clinical value of transcranial Doppler ultrasound (TCD) follow uppatients with MCAS.Method: We screened the out-patient and in-patient from July2010to January2011by TCD and consecutively recruited85patients (man45,women40,everage age72.1±9.30years) with the middle cerebral artery stenosis. All patients underwent carotidultrasonography, those of whom with ipsilateral carotid stenosis≥50%were excluded.Werandomly divided the patients into to high doses group (Atorvastatin40mg) and lowdose group (Atorvastatin10mg). All cases were recorded in generalstroke risk factors， serum plasma,hepatic and kidney function,creatine kinase levels,fasting plasma，glucose,glycosylated hemoglobin and medcines were administrated to all cases routinely totreat basic diseases.After6month follow-up,levels of lipid and lipid standards (LDL-C＜2.07mmol/l or LDL-C fell more than40%）as well as TCD were re-examined.Static-analysis was taken by SPSS version13.0for windows software. P value＜0.05(2-tailed) wasconsidered statistically significant.Results:1.At the end of6months,75patients complete the follow-up,of which high dosegroup enrolled40cases (mean age70.85±13.05years) and low dose group35cases(mean age69.51±10.19years),10(11.8%) cases were lost to follow up. There were nosignificant statistic difference in age, gender, histories of hypertension,diabetes,coronaryheart disease,stroke,hyperlipidemia,abuses of smoking and alcohol lipid level,liver andkidney function,creatine kinase,fasting blood glucose,glycosy lated hemoglobin(HbA1c)between two groups.2.75patients with94MCA stenosis,among the45stenosis in low dose group,14(31.1%)of the stenosis were mild,19(42.4%) were moderate,12(26.7%) were severe. Amongthe49stenosis in high dose group,11(22.4%) of the stenosis were mild,24(49.0%) weremoderate,14(28.6%) were severe. After6months of treatment,the results of follow-upTCD are shown below：(1)changes in patients with MCAS:Among the high-dose group,15(15/40,37.5%)patients had regressed MCAS,21(21/40,52.5%) patients had stationary MCAS,while4（4/40，10%）patients had progressed MCAS.Among the low dose group,6(6/35,17.1%)patients had regressed MCAS,21(21/35,60%) stationary MCAS,while8(8/35,22.9%)progressed MCAS.Therefore, patients with high-dose atorvastatin revealed more regressedand stable MCAS,less regressed MCAS than patients with low-dose atorvastatin.Whilethere were no significant difference between the two groups（x2=4.879，P﹥0.05）.(2)Change in94MCAS:Among the94MCAS,follow-up TCD revealed that MCAS inhigh-dose have more regressed vessels,less progressed vessels compared with low-dosegroup.Among49MCAS in high-dose group,follow-up TCD revealed23(46.9%) regressedMCAS,18(36.7%) stable MCAS and8(16.3%) progressed,when comparing with45 MCAS in low-dose group revealed9(19.6%) progressed MCAS,27(58.5%) remainedstable and10(21.7%) progressed.Of progressed MCAS,one was new-onset MCAS,otherswere progressed based on stenosis.There was statistically significant difference onstenosis vessels between two groups.2.After6months follow-up,patients with high-dose atorvastatin, of which32(80%)reached the LDL-C target goal,while21(60%) patients reached such goal in low-doseatorvastatin.It is showed more patients with LDL-C target achievement in high-dosegroup than those in low-dose group,while didn’t show statistically significant（x2=3.602, P＜0.05).However, patients with LDL-C target achievement have significantly moreregressed and stable MCAS,less progressed MCAS than those LDL-C didn’t reachtarget goal（x2=16.877, P＜0.01).3. recurrent ischemic stoke:The new and recurrent ischemic stroke rate was9.3%(7/75)during the6month follow-up.2patients in high-dose group developed ischemic strokeand were in the territory of MCA stenosis,while5patients in low-dose groupdeveloped ischemic stroke,4of which were in the territory of MCA stenosis,with nosignificant difference between two groups.4.changes in lipid: Compared with baseline,the levels of serumcholesterol (CHOL),triglyeride (TG), LDL-C were decreased significantly (P＜0.05),HDL-C increasedsignificantly(P＜0.05).Compared with two groups,the levels of CHOL,TG,LDL-C inhigh-dose group decreased more significantly and HDL-C increased moresignificantly.CHOL(4.60±0.65mmol/lvs.4.31±0.47mmol/l),TG(1.41±0.3mmol/lvs.1.22±0.29mmol/l),LDL-C(2.06±0.35mmol/lvs.1.89±0.21mmol/l),HDL-C(1.35±0.19mmol/l vs.1.44±0.20mmol/l), respectively.(P＜0.05).5.The security of atorvastatin:During the follow-up period,there was no side effects inpatients with low dose group and no hemorrhage events in two groups.3patients inhigh-dose group had transient elevations of ALT,AST and CK,but the levels didn’thigher than upper limit of normal value,and than returned to normal during the study.It proved that atorvastatin has excellent security.Conclusion:1. Atorvastatin therapy can stabilize or even reverse the progress of intracranial arterial stenosis, and the effect of high-dose atorvastatin is superior to low-dosesignificantly,and futher reduce the incidence and recurrence rate of ischemic stroke.2. The progress of moderate and severe MCAS is superior to mild MCAS withatorvastatin therapy.3. There are more patients with the level of LDL-C less than2.07mmol/l in atorvastatin40mg group,and significantly improved MCA stenosis.4. Atorvastatin40mg has a long term excellent security in Chinese patients.5. Transcranial Doppler ultrasound(TCD) examination can be used as a simplemethod to screen the intracranial arterial stenosis and evaluate its prognosis. |
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