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

DOI: 10.23736/S0390-5616.20.04959-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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