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Carotid Plaque With High-Risk Features in Embolic Stroke of Undetermined Source: Systematic Review and Meta-Analysis

Joseph Kamtchum-Tatuene1, Alan Wilman2, Maher Saqqur3

  • 1From the Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry (J.K.-T.), University of Alberta, Edmonton, Canada.

Stroke
|November 23, 2019
PubMed

Insights

Mild carotid stenosis with high-risk features is common in embolic stroke of undetermined source. These plaques are significantly more prevalent on the stroke side, suggesting a link to stroke risk.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Cardiology

Background:

  • Embolic stroke of undetermined source (ESUS) affects numerous patients.
  • Mild carotid stenosis (<50% narrowing) is often overlooked in ESUS.
  • This stenosis may be an unrecognized source of atheroembolism.

Purpose of the Study:

  • To determine the frequency of mild carotid stenosis with high-risk features in ESUS patients.
  • To compare the prevalence of these plaques ipsilaterally versus contralaterally.

Main Methods:

  • Systematic literature search of PubMed and Ovid-Embase.
  • Meta-analysis of pooled data on carotid plaque imaging features in ESUS.
  • Inclusion of eight studies with 323 participants.

Main Results:

  • Mild carotid stenosis with high-risk features occurred in 32.5% of ipsilateral carotids.
  • Prevalence in contralateral carotids was significantly lower at 4.6%.
  • Plaques with high-risk features were 5.5 times more likely in the ipsilateral carotid.

Conclusions:

  • High-risk plaques are substantially more common in the ipsilateral carotid artery in ESUS.
  • This finding suggests a potential causal relationship between ipsilateral mild carotid stenosis and stroke risk.
  • Further investigation into this association is warranted.

Keywords:
carotid stenosisodds ratioprevalenceriskstroke

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