Impact of Pre-treatment and Early Treatment with Statins on Safety and Efficacy Outcomes in Patients after Acute Ischemic Stroke Undergoing Endovascular Thrombectomy: A Systematic Review and Meta-Analysis (P5-13.010)

Objective: This study evaluates the impact of statin pre-treatment and early statin treatment on outcomes for patients with acute ischemic stroke (AIS) receiving endovascular thrombectomy. Background: The effect of early statin treatment and statin pre-treatment on prognosis after ischemic stroke in patients undergoing intra-arterial thrombectomy remains uncertain. Design/Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to June 2024. Early statin use was defined as in-hospital administration of statins post-stroke onset, while pre-treatment referred to regular statin use for prior indications. Efficacy outcomes included favorable functional outcomes at 90 days, reduced neurological deterioration, and an NIHSS improvement of 4 points or more from baseline. A favorable functional outcome was defined as a modified Rankin Scale (mRS) score of 0–2. Safety outcomes comprised symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and all-cause mortality. Statistical analyses were performed using R version 4.4.0. Results: Seven observational studies with 2,440 patients were included. Early statin use significantly improved favorable functional outcomes (mRS 0–2) in 90 days (RR 1.73; 95% CI 1.43–2.1; p<0.001; I2=44%) compared to no statins. Additionally, the incidence of any ICH (RR 0.52; 95% CI 0.36–0.75; p<0.001; I2=33%), neurological deterioration (RR 0.36; 95% CI 0.26–0.49; p<0.001; I2=0%), and mortality (RR 0.38; 95% CI 0.28–0.53; p<0.001; I2=15%) was lower in the early statins group. Statin pre-treatment significantly increased successful recanalization (OR 3.79; 95% CI 1.09–13.17; p=0.04; I2=68%), but did not significantly impact functional outcomes or neurological improvement (OR 1.35; 95% CI 0.69–2.65; p=0.38; I2=0%). Conclusions: This systematic review and meta-analysis found that early statin treatment significantly improves outcomes following endovascular thrombectomy, while statin pre-treatment enhances recanalization without affecting other outcomes. Further large randomized controlled trials are warranted. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Ms. Santos has nothing to disclose. Mr. Goncalves has nothing to disclose. Mr. Monteiro has nothing to disclose. Dr. Hong has nothing to disclose. Miss Machado Pereira has nothing to disclose. Mr. Fukunaga has nothing to disclose. Miss Faria has nothing to disclose. Mr. NOGUEIRA has nothing to disclose. Miss Vilardo has nothing to disclose. Ms. Ribeiro has nothing to disclose. Dr. Ferreira has nothing to disclose. Mr. Araújo de Oliveira has nothing to disclose. Prof. Almeida has nothing to disclose.