The effect of statin use on embolic potential during carotid angioplasty and stenting

Background: Statin use results in atherosclerotic plaque stabilization. We sought to determine the effects of statins on the size and number of embolic particles generated during carotid artery stenting (CAS). Methods: Embolic debris from carotid filters following CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, pre-operative cerebrovascular symptoms, statin use, and outcomes (peri-operative major adverse events, MAE) were reviewed. Results: Carotid filters from 62 consecutive CAS procedures were examined. The mean age is 68.7 ± 9.8 years, 64% were men, 41 (66%) were on statins at the time of CAS, and 27 (43.5%) had neurological symptoms pre-procedurally. The mean intra-procedural stenosis was similar between groups (statin: 89.4 ± 7.4% vs. no statin: 88.4 ± 5.9%, P = NS). There was no significant difference in overall pre-operative symptoms between the two groups. Statin users were more likely to have coronary artery disease (CAD, P = 0.02), hyperlipidemia (HL, P = 0.047), or have undergone coronary artery bypass (CABG, P = 0.01). Statin use was associated with significantly less embolic particles (statin: 16.4 ± 2.1 vs. no statin: 42.4 ± 9.5, P = 0.001) during CAS. Further, multivariate analysis controlling for CAD, HL, and CABG confirmed that statin use was independently associated with less captured debris (P = 0.005). There was no significant difference in the mean particle size (statin: 326.2 μm ± 31.1 vs. no statin 310.5 μm ± 41.8), peri-procedural stroke, and MAE between the two groups (P = NS). Conclusions: Statin use is associated with less embolic debris during CAS. Further investigation utilizing a larger study group is necessary to assess the impact of statin use on peri-procedural outcomes.