Novel strategies to prevent and treat stroke that are both safe and effective are desperately needed in order to alleviate the burden of post-stroke disability. Statins are widely used for secondary stroke prevention;however, concerns with regard to potential long-term side effects to date prevented prophylactic use of statins in patients at high-risk for stroke. In acute ischemic stroke (AIS), cerebral tissue damage and clinical outcomes have been linked to microvascular dysfunction, manifesting as white matter hyperintensity (WMH) on brain MRI. WMH burden is associated with infarct growth, hemorrhagic transformation, and worse clinical AIS outcomes. In AIS, vascular protective effects of statins may alleviate the degree of microvascular dysfunction and improve cerebral tissue and clinical outcomes, but this requires further investigation. We hypothesize that pre-stroke statin use in subjects with advanced WMH improves cerebral perfusion and decreases blood-brain barrier (BBB) disruption during AIS. In addition, patients with advanced WMH may derive additional benefits in cerebral perfusion and functional outcomes after AIS with early post-stroke statin initiation. We propose to investigate the effect of statin use on outcomes after stroke, utilizing WMH severity as a clinical model of microvascular dysfunction. Using a collaborative approach, we propose to: (1) determine whether pre-stroke statin use modifies the neuroimaging and plasma biomarkers of microvascular dysfunction and ischemic tissue fate in subjects with advanced WMH and AIS;and (2) assess whether statin exposure improves survival and functional outcomes in AIS subjects with advanced WMH. Neuroimaging and plasma biomarkers obtained before and after initiation of statin in subjects with AIS and advanced WMH will provide proof-of-concept data on the impact of statin therapy on microvascular dysfunction, and its role in cerebral tissue susceptibility to acute ischemia. This study will bridge a critical gap in knowledge about the effect and timing of statin therapy in the evolution of stroke. It addresses pre-emptive therapeutic AIS strategies to improve post-stroke outcomes. If successful, this study will provide data to support prophylactic use of statins in patients who are high-risk for stroke based on their WMH burden, and ultimately, it may lead to change in our standard of practice for primary stroke prevention, clarify the optimal window for initiation of statin therapy, and decrease the burden of post-stroke disability.

Public Health Relevance

Despite recent improvement in stroke mortality rates, patients often face the prospect of substantial post-stroke disability. This study aims to provide the evidence in support of a novel strategy to improve clinical outcomes after stroke that is both safe and effective. If successful, this research will change the existing practice guidelines with regard to primary stroke prevention and reducing the burden of post-stroke disability.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
5R01NS082285-02
Application #
8739320
Study Section
Brain Injury and Neurovascular Pathologies Study Section (BINP)
Program Officer
Moy, Claudia S
Project Start
Project End
Budget Start
Budget End
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02199
Karadeli, Hasan H; Giurgiutiu, Dan-Victor; Cloonan, Lisa et al. (2016) FLAIR Vascular Hyperintensity is a Surrogate of Collateral Flow and Leukoaraiosis in Patients With Acute Stroke Due to Proximal Artery Occlusion. J Neuroimaging 26:219-23
Charidimou, Andreas; Pasi, Marco; Fiorelli, Marco et al. (2016) Leukoaraiosis, Cerebral Hemorrhage, and Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis (v1). Stroke 47:2364-72
Zhang, Cathy R; Cloonan, Lisa; Fitzpatrick, Kaitlin M et al. (2015) Determinants of white matter hyperintensity burden differ at the extremes of ages of ischemic stroke onset. J Stroke Cerebrovasc Dis 24:649-54
Giurgiutiu, Dan-Victor; Yoo, Albert J; Fitzpatrick, Kaitlin et al. (2015) Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. J Neurointerv Surg 7:326-30
Rutten-Jacobs, Loes C A; Traylor, Matthew; Adib-Samii, Poneh et al. (2015) Common NOTCH3 Variants and Cerebral Small-Vessel Disease. Stroke 46:1482-7
Cloonan, Lisa; Fitzpatrick, Kaitlin M; Kanakis, Allison S et al. (2015) Metabolic determinants of white matter hyperintensity burden in patients with ischemic stroke. Atherosclerosis 240:149-53
Wu, Ona; Cloonan, Lisa; Mocking, Steven J T et al. (2015) Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes. Stroke 46:2438-44
Majersik, Jennifer J; Cole, John W; Golledge, Jonathan et al. (2015) Recommendations from the international stroke genetics consortium, part 1: standardized phenotypic data collection. Stroke 46:279-84
Adib-Samii, Poneh; Devan, William; Traylor, Matthew et al. (2015) Genetic architecture of white matter hyperintensities differs in hypertensive and nonhypertensive ischemic stroke. Stroke 46:348-53
Dalca, Adrian Vasile; Sridharan, Ramesh; Cloonan, Lisa et al. (2014) Segmentation of cerebrovascular pathologies in stroke patients with spatial and shape priors. Med Image Comput Comput Assist Interv 17:773-80

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