High-risk plaque characteristics associated with recurrent stroke in patients with intracranial stenosis: a
Xuan Shi1, Tao Tao2, Haiping Ling2
1Department of Geriatric Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, China. sxuan721@163.com.
Insights
High-risk plaque characteristics (HPCs) in intracranial atherosclerosis (ICAS) predict recurrent strokes. Identifying these HPCs aids in crucial risk stratification for patients with ICAS.
Area of Science:
- Neurology
- Cardiovascular Research
- Medical Imaging
Background:
- Intracranial atherosclerosis (ICAS) necessitates accurate risk stratification for stroke recurrence.
- Current imaging markers for predicting recurrent strokes in ICAS are insufficient.
- High-risk plaque characteristics (HPCs) are potential predictors of stroke recurrence.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic significance of HPCs in predicting recurrent stroke in patients with ICAS.
- To identify specific HPCs associated with increased risk of stroke recurrence.
- To evaluate the role of HPCs in risk stratification for ICAS patients.
Main Methods:
- Systematic literature search of PubMed, Ovid Medline, and Web of Science.
- Inclusion of 18 studies (13 prospective, 5 retrospective) with 4967 patients.
- Random-effects meta-analysis to pool data on HPCs and stroke recurrence risk.
Main Results:
- HPCs were associated with a significantly higher incidence of stroke recurrence in symptomatic ICAS patients (adjusted HR, 3.90).
- Specific HPCs like plaque enhancement, calcification, high plaque steepness, and progression increased recurrence risk.
- Traditional risk factors further elevated HPC-related stroke recurrence risk.
Conclusions:
- Identification of HPCs provides independent prognostic value for predicting stroke recurrence in ICAS.
- HPCs are instrumental in improving risk stratification for patients with ICAS.
- Further research into imaging markers for ICAS is warranted.
Background:
Risk stratification based on intracranial plaque characteristics is crucial for patients with intracranial atherosclerosis (ICAS). Nonetheless, there remains a significant deficit of validated imaging markers capable of predicting recurrent strokes. Consequently, we conducted a systematic review and meta-analysis to investigate the prognostic significance of high-risk plaque characteristics (HPCs) in relation to recurrent stroke.
Methods:
The systematic review was registered in PROSPERO (CRD420245820945). We systematically searched PubMed, Ovid Medline, and Web of Science for studies evaluating the association between HPCs and risk of stroke recurrence. Data were aggregated and pooled using a random-effects meta-analysis. Heterogenicity and publication bias were assessed, with subgroup and sensitivity analyses performed where appropriate.
Results:
Eighteen studies, comprising 13 prospective and 5 retrospective, involving a total of 4967 patients (3594 symptomatic, and 1373 asymptomatic), were included in the analysis. Among symptomatic patients, those with HPCs exhibited a higher incidence of stroke recurrence compared to those without HPCs (adjusted HR, 3.90 ([95% CI, 2.15-7.08]). ICAS patients with baseline plaque enhancement (adjusted HR, 5.20 [95% CI, 3.12-8.66]), calcification (adjusted HR, 2.92 [95% CI, 1.32-6.45]), high plaque steepness (adjusted HR, 110.27 [95% CI, 4.75-2559.74]), and progression in plaque burden (adjusted HR, 6.29 [95% CI, 1.62-24.45]) were identified as being at an increased risk of stroke recurrence. Subgroup analyses revealed that traditional cerebrovascular risk factors, including increasing age, hypertension, diabetes mellitus, and smoking, further elevated the risk of HPC-related stroke recurrence in ICAS patients.
Conclusion:
The identification of HPCs confers independent prognostic value for the prediction of stroke recurrence in ICAS patients, which could be instrumental for patients risk stratification.
