EPA and Rosuvastatin Stabilize the Unstable Carotid Plaques: A Prospective Randomized Clinical Trial

Abstract

Carotid plaque constituents such as hemorrhage, lipid core, fibrosis, and calcification are important factors in predicting the clinical outcome of carotid artery stenting (CAS). Magnetic resonance imaging (MRI) can noninvasively assess changes in carotid plaque composition by evaluating the Sp/Sm ratio calculated with the signal intensity of carotid plaque (Sp) compared to that of sternocleidomastoid muscle (Sm) using the black-blood technique. In the current study, we assessed the effects of 5 mg rosuvastatin and 1,800 mg eicosapentaenoic acid (EPA) on carotid plaque composition and volume using MRI and intravascular ultrasound prior to CAS. Thirty consecutive patients with atherosclerotic carotid stenosis were randomly divided into two groups—an EPA/rosuvastatin group (n=15) and a control group (n=15)—and then were treated with CAS. Perioperative complications and postoperative high spotty lesions on diffusion weighted image (DWI) were compared between the two groups. As a result, EPA and rosuvastatin significantly reduced the Sp/Sm ratio in both T1- and T2-weighted images in patients with unstable plaques (T1; p=0.021, T2; p=0.014). Plaque volume was also reduced between baseline and follow-up in 4 of 15 cases treated with EPA/rosuvastatin. The number of postoperative high spotty lesions on DWI significantly decreased in the EPA/rosuvastatin group (13%; 2/15) compared with the control group (40%; 6/15, p<0.05), whereas no significant difference was observed in perioperative complication rate. The combined therapy of EPA and rosuvastatin leads to a benefical effect on plaque composition and volume, which may contribute to reducing the ischemic complications with CAS, particular in patients with vulnerable plaque.