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

Asim Rizvi, Seyed M. Seyedsaadat, Muayad Alzuabi, Mohammed H. Murad, John Huston, Vance T. Lehman, Giuseppe Lanzino, Luca Saba, Waleed Brinjikji

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)480-486
Number of pages7
JournalJournal of neurosurgical sciences
Volume64
Issue number5
DOIs
StatePublished - Oct 2020

Keywords

  • Carotid stenosis
  • Magnetic resonance imaging
  • Meta-analysis
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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