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.
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.
|Traylor, Matthew; Malik, Rainer; Nalls, Mike A et al. (2017) Genetic variation at 16q24.2 is associated with small vessel stroke. Ann Neurol 81:383-394|
|Atchaneeyasakul, Kunakorn; Leslie-Mazwi, Thabele; Donahue, Kathleen et al. (2017) White Matter Hyperintensity Volume and Outcome of Mechanical Thrombectomy With Stentriever in Acute Ischemic Stroke. Stroke 48:2892-2894|
|Etherton, Mark R; Wu, Ona; Cougo, Pedro et al. (2017) Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke. Neurology 88:1701-1708|
|Etherton, Mark R; Wu, Ona; Cougo, Pedro et al. (2017) Structural Integrity of Normal Appearing White Matter and Sex-Specific Outcomes After Acute Ischemic Stroke. Stroke 48:3387-3389|
|Giese, Anne-Katrin; Schirmer, Markus D; Donahue, Kathleen L et al. (2017) Design and rationale for examining neuroimaging genetics in ischemic stroke: The MRI-GENIE study. Neurol Genet 3:e180|
|(2017) 19th Workshop of the International Stroke Genetics Consortium, April 28-29, 2016, Boston, Massachusetts, USA: 2016.001 MRI-defined cerebrovascular genomics-The CHARGE consortium. Neurol Genet 3:S2-S11|
|Etherton, Mark R; Rost, Natalia S; Wu, Ona (2017) Infarct topography and functional outcomes. J Cereb Blood Flow Metab :271678X17700666|
|Hinman, Jason D; Rost, Natalia S; Leung, Thomas W et al. (2017) Principles of precision medicine in stroke. J Neurol Neurosurg Psychiatry 88:54-61|
|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|
|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|
Showing the most recent 10 out of 26 publications