Statin versus no statin after treatment with pipeline embolization device for intracranial aneurysms: a meta-analysis

TL;DR

This study finds that statin use after a pipeline embolization device may reduce bleeding risks, but not ischemic complications or aneurysm occlusion rates.

Contribution

The study is the first to meta-analyze the effects of statins after pipeline embolization device treatment for intracranial aneurysms.

Findings

Statin use was associated with reduced hemorrhagic complications after pipeline embolization.

No significant difference in complete aneurysm occlusion rates was found between statin and non-statin groups.

Ischemic complications were higher in the statin group, but the result was not statistically significant after matching.

Abstract

Some studies demonstrated the role of statin therapy in improving outcomes after coil embolization or surgical clipping of cerebral aneurysm. However, the benefit of statins after pipeline embolization device (PED) for intracranial aneurysms is not well established.

To evaluate the effects of statins on hemorrhagic and ischemic complications as well as on complete occlusion of aneurysm in the treatment with PED.

We searched the PubMed, Embase, and Cochrane Library databases for articles published from their inception to November 2024. Data were collected from observational studies comparing statin to no statin therapy following pipeline embolization.

Four studies were included, comprising 2,822 patients and 3,063 aneurysms, 127 of which were ruptured and 4 of which received adjunctive coil embolization. Total hemorrhagic complication was reduced in the statin group (risk ratio [RR] = 0.50; 95%CI: 0.29–0.85;
p
 = 0.010; I
2
 = 0%) but did not reveal difference in restricted propensity score-matched (PSM) analysis (RR= 0.50; 95%CI: 0.24–1.07
p
 = 0.073; I
2
 = 27%). There was no difference between the groups in complete occlusion of aneurysm rate at the last follow-up (RR = 0.94; 95%CI: 0.88–1.00;
p
 = 0.055; I
2
 = 8.0%) or total ischemic complications (RR = 1.48; 95%CI: 1.06–2.07;
p
 = 0.021; I
2
 = 0%).

Statin use significantly reduced hemorrhagic complications after PED; however, this result should be interpreted cautiously due to study limitations. No significant differences were noted in complete occlusion rates or ischemic complications between the groups.

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