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.

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.

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%).

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.