Dawei Wang, Jingya Dai, Shumei Li, Yaping Liu, Xiaofeng Xing, Lei Huang, Qijun Pang
The present study aimed to assess whether atorvastatin enhances indirect revascularization outcomes in adult ischemic moyamoya disease (MMD). In a randomized trial, 80 adults received postoperative atorvastatin (20 mg/day, n=40) or standard care (n=40); the primary outcome was good neovascularization (Matsushima grade, Good) at 6 months. The results revealed that good neovascularization was higher with atorvastatin (65.0 vs. 37.5%; risk ratio, 1.73; P=0.014). In addition, the atorvastatin group exhibited greater improvement in cerebral blood flow (mean difference, 4.3 ml/100 g/min; P<0.001) and functional outcome (72.5 vs. 50.0% with modified Rankin Scale improvement; P=0.039). Ischemic event recurrence was also lower in the atorvastatin group (2.5 vs. 12.5%; P=0.201), whereas safety profiles were similar. In conclusion, the present single-center randomized trial provides preliminary evidence that adjunctive atorvastatin may improve collateral formation, cerebral perfusion and functional status after indirect revascularization in adult ischemic MMD. Large-scale multi-center studies are warranted to validate these findings. This trial was registered in the Chinese Clinical Trial Registry as trail no. ChiCTR1800016363, on June 3, 2018.