Imagine a raging river, powerful and unforgiving. But what if you had two mighty warriors working together to tame it? That’s the story of PCSK9 inhibition and statin therapy teaming up to battle intracranial atherosclerotic stenosis (ICAS), a common cause of stroke worldwide. In this study, researchers investigated the effects of combining PCSK9 inhibition with statin therapy on the intracranial plaques of individuals with ICAS. Using high-resolution MRI, they discovered that the team effort led to significant reductions in plaque severity and stenosis degree compared to statin therapy alone. Additionally, a greater percentage of individuals showed a good response to treatment in the PCSK9 inhibition group. While major vascular events were similar between the groups, further investigation is needed to determine if this combination treatment improves clinical outcomes for ICAS patients. Through this breakthrough research, we gain valuable insights into how these two powerful therapies can work together to mitigate the impact of ICAS. Dive deeper into the study’s findings and unlock the potential of PCSK9 inhibition and statin therapy in taming intracranial atherosclerosis!

IntroductionIntracranial atherosclerotic stenosis (ICAS) is a common cause of stroke worldwide. Evolocumab, a proprotein convertase subtilisin/kexin type-9 inhibitor (PCSK9i), effectively lowers low-density lipoprotein (LDL) and produces favorable changes in coronary atherosclerosis. This study aimed to determine the effects of PCSK9i on intracranial plaques in moderate-intensity statin-treated individuals with ICAS.MethodsThis prospective, observational study monitored the imaging and clinical outcomes of individuals with ICAS who were consecutively treated with moderate-intensity statins with or without PCSK9i. Individuals underwent monthly visits and repeat high-resolution MRI (HR-MRI) at week 12. The primary outcome was a change in HR-MRI after 12 weeks of treatment and the secondary outcome was major vascular events during follow-up.ResultsForty-nine individuals were studied (PCSK9i group: 26 individuals with 28 abnormal vascular regions; statin group: 23 with 27 regions). The PCSK9i group showed a significant reduction in the normalized wall index (0.83 vs. 0.86, p = 0.028) and stenosis degree (65.5 vs. 74.2%, p = 0.01). Similarly, a greater percentage of individuals with a good response to the efficacy of treatment were treated in the PCSK9i group than that in the statin group (75 vs. 44.4%, p = 0.021). The incidence of major vascular events was overall similar between the groups. The treatment options (OR = 8.441, p = 0.01) and prior diabetes (OR = 0.061, p = 0.001) were significantly associated with the efficacy of treatment.DiscussionStatin and PCSK9i combination treatment stabilized intracranial atherosclerotic plaques more often compared to statins alone, as documented by HR-MRI. Further study is warranted to determine if combination treatment improves clinical outcomes in ICAS.

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