RT Journal Article
SR Electronic
T1 The Risk of Stroke and TIA in Nonstenotic Carotid Plaques: A Systematic Review and Meta-Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A6613
A1 Singh, N.
A1 Marko, M.
A1 Ospel, J.M.
A1 Goyal, M.
A1 Almekhlafi, M.
YR 2020
UL http://www.ajnr.org/content/early/2020/07/09/ajnr.A6613.abstract
AB BACKGROUND: Severe carotid stenosis carries a high risk of stroke. However, the risk of stroke with nonstenotic carotid plaques (<50%) is increasingly recognized.PURPOSE: We aimed to summarize the risk of TIA or stroke in patients with nonstenotic carotid plaques.DATA SOURCES: We performed a comprehensive systematic review and meta-analysis in patients with acute ischemic stroke in whom carotid imaging was performed using MEDLINE and the Cochrane Database, including studies published up to December 2019.STUDY SELECTION: Included studies had >10 patients with <50% carotid plaques on any imaging technique and reported the incidence or recurrence of ischemic stroke/TIA. High-risk plaque features and the risk of progression to stenosis >50% were extracted if reported.DATA SYNTHESIS: We identified 31 studies reporting on the risk of ipsilateral stroke/TIA in patients with nonstenotic carotid plaques. Twenty-five studies (n = 13,428 participants) reported on first-ever stroke/TIA and 6 studies (n = 122 participants) reported on the recurrence of stroke/TIA.DATA ANALYSIS: The incidence of first-ever ipsilateral stroke/TIA was 0.5/100 person-years. The risk of recurrent stroke/TIA was 2.6/100 person-years and increased to 4.9/100 person-years if intraplaque hemorrhage was present. The risk of progression to severe stenosis (>50%) was 2.9/100 person-years (8 studies, n = 448 participants).LIMITATIONS: Included studies showed heterogeneity in reporting stroke etiology, the extent of stroke work-up, imaging modalities, and classification systems used for characterizing carotid stenosis.CONCLUSIONS: The risk of recurrent stroke/TIA in nonstenotic carotid plaques is not negligible, especially in the presence of high-risk plaque features. Further research is needed to better define the significance of nonstenotic carotid plaques for stroke etiology.ASyNCasymptomatic nonstenotic carotid plaquesESUSembolic stroke of undetermined sourcePICOSPopulation, Intervention; Control or comparator; OutcomesSyNCsymptomatic nonstenotic carotid plaquesECSTEuropean Carotid Surgery Trial