The study, led by Yisen Zhang, MD, of Beijing Tiantan Hospital and Capital Medical University, was published in Radiology and provides evidence that statins may help stabilize aneurysm pathology through anti-inflammatory effects.
VBDAs are significant contributors to stroke, and wall enhancement on vessel wall MRI (VW MRI) is considered a marker of inflammation and aneurysm vulnerability. While previous studies have shown that statins reduce inflammation in intracranial saccular aneurysms, their effect on VBDAs has remained unclear.
In an open-label randomized controlled trial, Zhang and colleagues enrolled 40 participants with unruptured VBDAs between July 2021 and January 2023. Participants were randomized 1:1 to receive daily 20 mg atorvastatin or no statin treatment and underwent VW MRI at baseline and six months. The primary outcomes included changes in aneurysm wall enhancement, measured by the wall enhancement index (WEI) and three-dimensional wall enhancement volume rate (WEVR). Secondary outcomes included alterations in aneurysm morphology and circulating inflammation biomarkers.
The study revealed the following findings:
- After six months, patients receiving statins showed significant reductions in aneurysm wall enhancement compared with baseline.
- The mean change in wall enhancement index (WEI) was −0.3 in the statin group versus 0.1 in the control group.
- Wall enhancement volume rate (WEVR) decreased by 15.1% in the statin group, while it increased by 5.3% in controls.
- Circulating inflammatory markers, including C-reactive protein, tumor necrosis factor–alpha, interleukin-6, and interleukin-1β, were significantly lower in the statin group.
- Progression of intramural hematomas was slower in patients treated with atorvastatin compared with controls (304.0 mm³ vs 100.3 mm³).
- No significant change in aneurysm size was observed in either group.
The authors highlighted that statins not only reduced VW MRI-detected inflammation but also stabilized intramural hematomas, suggesting a multifaceted role in mitigating VBDA-related stroke risk. Representative imaging from a 35-year-old patient with a vertebral artery dissection showed clear reductions in both WEI and WEVR over six months, demonstrating the measurable effect of statin therapy on aneurysm wall pathology.
In an
accompanying commentary, Bahram Mohajer, MD, and Victoria Chernyak, MD, noted that the critical question is whether reduced VW enhancement translates into clinically meaningful benefits for patients. They emphasized that if validated, VW MRI biomarkers could become central to personalized VBDA management—helping to identify patients with active aneurysms who may benefit from medical therapy, guiding surveillance intervals, and informing the timing of interventions.
The study provides compelling evidence that statins can reduce vessel wall inflammation in unruptured VBDAs, complementing their known cardiovascular benefits. While the results are promising, further research is needed to confirm whether these imaging improvements translate into lower rates of aneurysm rupture or stroke, potentially establishing VW MRI as a key tool in the management of high-risk aneurysms.
Reference:
Zhang Y, Wang C, Dong L, Turhon M, Kang H, Liu J, Duan Y, Tian D, Sui B, Zhang Y, Wang K, Mossa-Basha M, Yang X, Zhu C. Statins Reduce Wall Enhancement at Vessel Wall MRI in Unruptured Vertebrobasilar Dissecting Aneurysms: A Randomized Controlled Trial. Radiology. 2025 Dec;317(3):e242806. doi: 10.1148/radiol.242806. PMID: 41432563.
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