High Dose of Atorvastatin for the Treatment of Contrast-Induced Nephropathy After Carotid Artery Stenting.

Statins have been used to prevent contrast-induced nephropathy (CIN). However, the optimal dose of statins is still under controversy. This study aimed to investigate the optimal dose of atorvastatin for the treatment of CIN after carotid artery stenting (CAS). Seventy-six patients receiving selective CAS were randomized to receive 3 different dose of atorvastatin (low dose, 20 mg, n = 30; intermediate dose, 40 mg, n = 24; high dose, 60 mg, n = 22). Preoperatively and on day 3 postoperatively, the levels of serum creatinine, blood urea nitrogen, high-sensitivity C-reactive protein (hs-CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK) were measured. Creatinine clearance (Ccr) and CIN incidence were calculated. In patients treated with high-dose atorvastatin, no significant change was observed in levels of serum creatinine (Scr), blood urea nitrogen (BUN), creatinine clearance, and high-sensitivity C-reactive protein after the CAS procedure (P > 0.05). The CIN incidence in the high-dose group (0%) was significantly lower than the low-dose (13.3%) and intermediate (8.3%) groups (P < 0.05). In the high-dose group, levels of alanine aminotransferase, aspartate aminotransferase, and creatine kinase were significantly increased after CAS (P < 0.05). Pretreatment with 40 mg of atorvastatin is both effective and safe in preventing CIN after CAS. Adverse events of the live and heart should be closely monitored during atorvastatin treatment.

Efficacy of Solitaire Stent Arterial Embolectomy in Treating Acute Cardiogenic Cerebral Embolism in 17 Patients.

BACKGROUND Thrombolysis with rtPA is the only accepted drug therapy for acute ischemic stroke. Since acute cerebral stroke is so pervasive, newly developed recanalization methods have the potential for wide-ranging impacts on patient health and safety. We explored the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism. MATERIAL AND METHODS Between October 2012 and June 2015, 17 patients underwent Solitaire stent arterial embolectomy, either alone or in combination with rtPA intravenous thrombolysis, to treat acute cardiogenic cerebral embolism. Sheath placement time, vascular recanalization time, number of embolectomy attempts, and IV rtPA dose and time were recorded. Success and safety of the recanalization procedure, as well as clinical outcomes, were assessed. These results were compared to 16 control patients who were treated using only rtPA IV thrombolysis. RESULTS Full recanalization of the occluded arteries was achieved in 15 (88.2%) of the Solitaire stent patients. NIH Stroke Scale scores of embolectomy patients improved by an average of 12.59 ± 8.24 points between admission and discharge, compared to 5.56 ± 5.96 in the control group (P<0.05). Glasgow Coma Score improvement between admission and discharge was also significantly higher in the embolectomy group (P<0.05). There was no significant difference in symptomatic intracerebral hemorrhage, high perfusion encephalopathy, incidence of hernia, or mortality between the 2 groups (P>0.05). CONCLUSIONS Solitaire stent embolectomy is a safe and effective alternative to simple venous thrombolytic therapy, and it can significantly improve short-term neurological function and long-term prognosis in acute cardiogenic cerebral embolism.