Carotid plaque magnetic resonance imaging and recurrent stroke risk: A systematic review and meta-analysis
Fengbin Deng1,2, Changping Mu1,2, Ling Yang1
1Radiology Department, Chongqing General Hospital, University of Chinese Academy of Science.
Background:
MRI findings of carotid plaque components have been studied recently as a tool to predict recurrent ischemic events. We performed a systematic review and meta-analysis to summarize the association of MRI-determined intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap with recurrent ischemic events.
Methods:
Electronic search was performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to Oct 30, 2018. We included cohort studies with an average follow-up time of more than 1 month in which intraplaque hemorrhage, lipid-rich necrotic core, or thinning/rupture of the fibrous cap were associated with recurrent ipsilateral stroke or ischemic events. We performed heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we selected fixed-effect model for meta-analysis of the included cohort studies.
Results:
Using a prespecified search strategy, of the 2128 articles, 6 studies with a total number of 621 participants met eligibility for systematic review and meta-analysis. The hazard ratios of intra-plaque hemorrhage, thinning/rupture of the fibrous cap and lipid rich necrotic core as recurrent Stroke/Transient ischemic attack (TIA) were 7.14(95% confidence interval, 4.32 to 11.82), 5.68(95% confidence interval, 2.40 to 13.47), and 2.73(95% confidence interval, 1.04 to 7.16), respectively. No significant heterogeneity was found in the 3 meta-analyses.
Conclusions:
The presence of intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap on MRI of carotid plaque are strong predictors of recurrent stroke events. However, due to the lack of original studies, larger cohort studies are warranted.
Insights
MRI of carotid plaque components like intraplaque hemorrhage and lipid-rich necrotic core strongly predict recurrent ischemic events. These findings highlight the importance of plaque characterization for stroke risk assessment.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Carotid plaque components visualized by MRI are increasingly studied for predicting recurrent ischemic events.
- Understanding these plaque features is crucial for managing patients at risk of stroke.
Purpose of the Study:
- To systematically review and meta-analyze the association between MRI-determined carotid plaque components and recurrent ischemic events.
- To quantify the predictive value of intraplaque hemorrhage, lipid-rich necrotic core, and fibrous cap abnormalities for stroke recurrence.
Main Methods:
- A systematic electronic search of PUBMED, EMBASE, and CENTRAL was conducted up to October 30, 2018.
- Included were cohort studies with >1 month follow-up assessing MRI-defined plaque components and recurrent ipsilateral stroke/ischemic events.
- Fixed-effect meta-analysis was performed due to assessed low heterogeneity.
Main Results:
- Six studies with 621 participants met the eligibility criteria.
- Intraplaque hemorrhage showed a hazard ratio (HR) of 7.14 (95% CI, 4.32-11.82) for recurrent stroke/TIA.
- Thinning/rupture of the fibrous cap had an HR of 5.68 (95% CI, 2.40-13.47), and lipid-rich necrotic core had an HR of 2.73 (95% CI, 1.04-7.16).
Conclusions:
- MRI-detected intraplaque hemorrhage, lipid-rich necrotic core, and fibrous cap abnormalities are significant predictors of recurrent stroke.
- Larger cohort studies are recommended to further validate these findings due to the limited number of original studies.
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