Assessment of Therapeutic Response to Statin Therapy in Patients With Intracranial or Extracranial Carotid Atherosclerosis by Vessel Wall MRI: A Systematic Review and Updated Meta-Analysis.
Assessment of Therapeutic Response to Statin Therapy in Patients With Intracranial or Extracranial Carotid Atherosclerosis by Vessel Wall MRI: A Systematic Review and Updated Meta-Analysis.
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DOI：
10.3389/fcvm.2021.742935
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发表时间：
2021
影响因子：
3.6
通讯作者：
Zhu C
中科院分区：
文献类型：
--
作者：
Zhou P;Wang Y;Sun J;Yu Y;Mossa-Basha M;Zhu C
背景和目的：他汀类药物治疗是心血管疾病预防保健的重要组成部分。近年来，各种血管壁MRI（VW-MRI）技术已被用于监测颅外或颅内大动脉粥样硬化患者的动脉粥样硬化进展或消退。我们旨在通过VW-MRI评估他汀类药物治疗对斑块演变的影响，并进行系统回顾和荟萃分析。材料与方法：在文献中系统地识别了通过连续VW-MRI监测的对接受他汀类药物治疗的患者的颈动脉和颅内动脉粥样硬化斑块进行研究的前瞻性研究。提取并总结颈动脉斑块的斑块负荷、富脂坏死核心（LRNC）体积及颅内斑块的影像学特征。对于研究颈动脉壁体积和LRNC体积的研究，通过荟萃分析得出联合估计值。结果：该研究确定了21项颈动脉斑块研究和2项颅内斑块研究。荟萃分析纳入了16项颈动脉斑块研究，包括780例高分辨率VW-MRI患者。从基线到12个月，颈动脉壁体积没有显著变化。与基线相比，在> 12个月时观察到LRNC体积的显著变化（效应= −10.69，95%CI = −19.11，−2.28，P < 0.01），而在6项研究中，在开始他汀类药物治疗后3-6个月或7-12个月时，LRNC体积无显著变化。他汀类药物治疗后，分别在2/3项研究（包括48/59例患者）、1/3项研究（包括17/54例患者）和2/2项研究（包括71例患者）中观察到纤维组织和钙增加以及斑块新生血管密度降低。两项纳入257例颅内动脉粥样硬化患者的研究表明，他汀类药物可有效降低壁体积和斑块增强体积。结论：集体数据表明，他汀类药物可以通过显着降低LRNC与1年的治疗，如连续颈动脉VW-MRI显示，潜在的稳定颈动脉斑块。有没有显着的减少，在壁体积，这仍然表明，斑块组成的变化可能是更敏感的响应监测比壁体积。将来可能会开发出更敏感、临床相关、最好是定量的颅内血管斑块形态学治疗效果指标。
Background and Aims: Statin therapy is an essential component of cardiovascular preventive care. In recent years, various vessel wall MRI (VW-MRI) techniques have been used to monitor atherosclerosis progression or regression in patients with extracranial or intracranial large-artery atherosclerosis. We aimed to perform a systematic review and meta-analysis on the effects of statin therapy on plaque evolution as assessed by VW-MRI. Materials and Methods: Prospective studies investigating carotid and intracranial atherosclerotic plaques in patients on statin therapy monitored by serial VW-MRI were systematically identified in the literature. The plaque burden and lipid-rich necrotic core (LRNC) volume of carotid plaque and the imaging features of intracranial plaques were extracted and summarized. For studies investigating carotid artery wall volume and LRNC volume, combined estimates were derived by meta-analysis. Results: The study identified 21 studies of carotid plaque and two studies of intracranial plaque. While 16 studies investigating carotid plaques that included 780 patients by High-resolution VW-MRI were included in the meta-analysis. There was no significant change in carotid wall volume from baseline to 12 months. A significant change in LRNC volume was observed at > 12 months compared with baseline (Effect = −10.69, 95% CI = −19.11, −2.28, P < 0.01), while no significant change in LRNC volume at 3–6 months or 7–12 months after statin therapy initiation in 6 studies. Increases in fibrous tissue and calcium and reduction in neovascularization density of the plaque were seen in 2/3 studies (including 48/59 patients), 1/3 studies (including 17/54 patients), and 2/2 studies (including 71 patients) after statin therapy, respectively. Two studies with 257 patients in intracranial atherosclerosis showed that statins could effectively decrease wall volume and plaque enhancement volume. Conclusions: Collective data indicated that statins could potentially stabilize carotid plaques by significantly reducing LRNC with 1 year of therapy as shown on serial carotid VW-MRI. There was no significant decrease in wall volume, which nonetheless indicated that plaque composition changes might be more sensitive to response monitoring than wall volume. It is likely that more sensitive, clinically relevant, and preferably quantitative indicators of therapeutic effects on intracranial vessel plaque morphology will be developed in the future.
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DOI：
10.1038/ncpcardio1444
发表时间：
2009-03
期刊：
NATURE CLINICAL PRACTICE CARDIOVASCULAR MEDICINE
影响因子：
--
作者：
El Aidi, Hamza;Mani, Venkatesh;Weinshelbaum, Karen B.;Aguiar, Silvia H.;Taniguchi, Hiroaki;Postley, John E.;Samber, Daniel D.;Cohen, Emil I.;Stern, Jessica;van der Geest, Rob J.;Reiber, Johan H. C.;Woodward, Mark;Fuster, Valentin;Gidding, Samuel S.;Fayad, Zahi A.
通讯作者：
Fayad, Zahi A.
影响因子：
2.3
作者：
Beddhu S;Boucher RE;Sun J;Balu N;Chonchol M;Navaneethan S;Chertow GM;Townsend R;Haley W;Cheung AK;Conroy MB;Raj DS;Xu D;George T;Yunis R;Wei G;Canton G;Bates J;Chen J;Papademetriou V;Punzi H;Wiggers A;Wright JT;Greene T;Yuan C
通讯作者：
Yuan C
继续和停止他汀类药物治疗的受试者颈动脉斑块组织成分的变化
影响因子：
4.4
作者：
Du, Ruixue;Zhao, Xue-Qiao;Ye, Ping
通讯作者：
Ye, Ping
影响因子：
24
作者：
Corti, R;Fuster, V;Badimon, JJ
通讯作者：
Badimon, JJ
中国急性缺血性脑卒中患者大脑中动脉和颅外颈动脉粥样硬化斑块负荷的 MRI 特征：关联性和临床相关性。
影响因子：
1.9
作者：
Cao, Ye;Sun, Yi;Liu, Xiaosheng
通讯作者：
Liu, Xiaosheng