Prognostic Role of Carotid Plaque MRI Features in Cerebrovascular Accidents: A Systematic Review and Meta-analysis
Hossein Hemmati1, Amirhossein Larijani2, Amirabbas Mollaei3
1Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Background:
Characteristics of carotid plaques reported by magnetic resonance imaging (MRI) has been recently used to predict cerebrovascular accidents (CVA). We conducted this systematic review and meta-analysis to summarize the association of MRI-reported intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent CVAs.
Methods:
Comprehensive search was performed in PubMed, Scopus, and Web of Science databases from inception to September 19, 2024. We included cohort studies evaluating IPH, LRNC, and TRFC carotid plaques with the mean follow-up of ≥1 month, and outcome of the first stroke or transient ischemic attack. A random effect model with assessment of study heterogeneity and publication bias was applied.
Results:
Of 5342 studies screened, 13 articles with a total subject of 2729 met the eligibility for systematic review. The hazard ratios (HR) for IPH, LRNC, and TRFC as predictors of CVA were 4.64 (95 % confidence interval (CI), 3.31-6.5), 2.89 (95 % CI, 1.5-5.57), 5.02 (95 % CI, 2.8-8.99), respectively. This demonstrates a significant association between these MRI features and an increased risk of CVA. The subgroup analysis showed no significant difference between the asymptomatic and the symptomatic groups. No significant heterogeneity was found in the meta-analyses.
Conclusions:
The presence of IPH, LRNC, and TRFC on MRI reports of carotid plaques are significant predictors of cerebral ischemic events beyond measurement of luminal stenosis. MRI could identify at risk patients who might benefit from revascularization.
Insights
Magnetic resonance imaging (MRI) features like intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and fibrous cap rupture (TRFC) significantly predict cerebrovascular accidents (CVA). These MRI findings identify high-risk patients for potential revascularization.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Carotid plaque characteristics visualized by MRI are increasingly used to predict cerebrovascular accidents (CVA).
- Key MRI-detected features include intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC).
Purpose of the Study:
- To systematically review and meta-analyze the association between MRI-reported carotid plaque features (IPH, LRNC, TRFC) and subsequent CVAs.
- To evaluate the predictive value of these plaque characteristics for cerebrovascular events.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases.
- Included were cohort studies with a mean follow-up of ≥1 month, reporting on IPH, LRNC, and TRFC in carotid plaques and subsequent stroke or transient ischemic attack.
- A random effects model was employed to assess study heterogeneity and publication bias.
Main Results:
- 13 studies involving 2729 participants met the eligibility criteria.
- Hazard ratios (HR) for CVA were 4.64 for IPH, 2.89 for LRNC, and 5.02 for TRFC, indicating significant predictive value.
- No significant heterogeneity was observed, and subgroup analysis showed no difference between asymptomatic and symptomatic groups.
Conclusions:
- MRI-identified IPH, LRNC, and TRFC in carotid plaques are significant predictors of cerebral ischemic events, independent of luminal stenosis.
- These MRI findings can help identify patients at high risk who may benefit from revascularization therapies.
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