REVIEW   

Journal of Neurosurgical Sciences 2020 October;64(5):480-6

DOI: 10.23736/S0390-5616.20.04959-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Carotid plaque vulnerability on magnetic resonance imaging and risk of future ischemic events: a systematic review and meta-analysis

Asim RIZVI ^{1, 2}, ✉, Seyed M. SEYEDSAADAT ¹, Muayad ALZUABI ³, Mohammed H. MURAD ³, John HUSTON ³rd ¹, Vance T. LEHMAN ¹, Giuseppe LANZINO ⁴, Luca SABA ⁵, Waleed BRINJIKJI ^{1, 6}

¹ Department of Radiology, Mayo Clinic, Rochester, MN, USA; ² Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA, 3 Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA; ⁴ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; ⁵ Department of Radiology, University of Cagliari, Cagliari, Italy; ⁶ Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada

INTRODUCTION: Magnetic resonance imaging (MRI) can characterize carotid plaque features, including intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap (TRFC), that have increased tendency to cause future cerebrovascular ischemic events. We performed a systematic review and meta-analysis of studies evaluating association of MRI-identified high-risk plaque features, including IPH, LRNC, and TRFC, with risks of subsequent ischemic events of stroke, transient ischemic attack (TIA), or amaurosis fugax (AF) over follow-up duration of ≥3 months.
EVIDENCE ACQUISITION: Multiple databases were searched for relevant publications between January 2000 and March 2020. Studies reporting outcomes of future ischemic events of stroke, TIA, or AF for individual MRI-identified high-risk carotid plaque features over follow-up duration of ≥3 months were included. Random effects meta-analysis was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing outcomes between MRI-positive and MRI-negative groups.
EVIDENCE SYNTHESIS: Fifteen studies including 2350 patients were included. The annual rate of future ischemic events was 11.9% for MRI-positive IPH, 5.4% for LRNC, and 5.7% for TRFC. IPH, LRNC, and TRFC were associated with increased risk of future ischemic events (OR 6.37; 95% CI, 3.96 to 10.24), (OR 4.34; 95% CI, 1.65 to 11.42), and (OR 10.60, 95% CI 3.56 to 31.58), respectively.
CONCLUSIONS: The current study findings strengthen the assertion that MRI-positive “high-risk” or “vulnerable” plaque features, including IPH, LRNC, and/or TRFC can predict risks of future ischemic events of stroke, TIA, or AF.

KEY WORDS: Stroke; Magnetic resonance imaging; Meta-analysis; Carotid stenosis