Role of Statins in the Clinical and Radiologic Outcomes of Patients with Unruptured Intracranial Aneurysm Undergoing Microsurgery or Endovascular Treatment: A Systematic Review and Meta-Analysis.

[BACKGROUND] The impact of statin pretreatment on outcomes for patients undergoing endovascular treatment of intracranial aneurysms remains uncertain. We aimed to conduct a systematic review and meta-analysis evaluating the efficacy and safety of statins in this population.

[METHODS] We searched the PubMed/MEDLINE, Embase, Scopus, and Web of Science databases from inception to August 1, 2024. This study compares the outcomes between statin users and nonusers undergoing endovascular aneurysm treatment.

[RESULTS] Eight studies with 5862 patients were included. Complete occlusion rates after endovascular aneurysm treatment were similar between statin users and nonusers (pooled odds ratio [OR], 0.93; 95% confidence interval [CI], 0.70-1.23). Statin use was associated with a significantly increased risk of ischemic stroke (pooled OR, 1.51; 95% CI, 1.03-2.19, P = 0.03). No differences were seen in neurologic mortality (pooled OR, 0.74; 95% CI, 0.21-2.57; P = 0.63), all-cause mortality (pooled OR, 0.68; 95% CI, 0.16-2.90, P = 0.61), or retreatment rates (pooled OR, 0.76; 95% CI, 0.35-1.66; P = 0.49). Statin therapy was associated with decreased hemorrhagic complication (pooled OR, 0.45; 95% CI, 0.24-0.85; P = 0.01) but did not affect thrombosis risk (pooled OR, 1.28; 95% CI, 0.68-2.40; P = 0.45) and statin use decreased in-stent stenosis (OR, 2.31, 95% CI, 1.51-3.52; P = 0.001).

[CONCLUSIONS] Statin pretreatment may decrease the risk of hemorrhagic complications and in-stent stenosis after endovascular aneurysm therapy but does not improve angiographic occlusion. An increased hazard of ischemic events was found. Further data are needed to validate these findings and clarify the role of statins in patients with aneurysms undergoing endovascular procedures.