Non-invasively detected unstable carotid plaque characteristics, particularly intraluminal thrombus (OR 7.21; 95% CI 3.05-17.05), were associated with a higher risk of stroke in symptomatic patients.
Meta-Analysis (n=2,430)
Does the presence of noninvasively detected unstable carotid plaque characteristics increase the risk of recent ischemic cerebrovascular events in symptomatic patients?
Noninvasively detected unstable carotid plaque characteristics, particularly intraluminal thrombus and ruptured fibrous cap, are strongly associated with recent ischemic cerebrovascular events in symptomatic patients.
Effect estimate: OR 7.21 (95% CI 3.05-17.05)
Abstract Background and aims Carotid plaque composition beyond stenosis degree plays major role in development of stroke. Detecting high-risk plaque features is important for patient risk stratification, but many studies have presented heterogeneous results on this association. We aimed to identify noninvasively detected plaque characteristics associated with recent ischemic cerebrovascular events in symptomatic patients. Methods After prospective registration (PROSPERO CRD42022343814), Medline Ovid, Embase.com, Cochrane Library, and WoS were searched without any search limitations for studies that included recently symptomatic patients with extracranial carotid atherosclerosis detected by CT/MRI/ultrasound. Plaque composition, evaluated conventionally and using Plaque-RADS, in symptomatic carotid compared to asymptomatic carotid was extracted. Newcastle-Ottawa Scale assessed studies quality, and fixed-effect meta-analysis (Mantel–Haenszel method) was used for data analysis. Results In the included 14 studies/2,430 patients, noninvasively detected intraluminal thrombus/Plaque-RADS 4c (odds ratioOR=7.21, 95%CI 3.05–17.05), ruptured fibrous cap/Plaque-RADS 4b (OR=2.52, 95%CI 1.68–3.77), complicated plaque (OR=2.12, 95%CI 1.74–2.59), and intraplaque hemorrhage/Plaque-RADS 4a (IPH; OR 1.95, 95%CI 1.44–2.65) represented the most stroke risk plaque features. Unstable plaque characteristics were associated with stroke (OR=1.9;Figure 1) compared with stable ones (OR=0.78). In non-stenotic ESUS patients (5 studies/415 patients), ulceration/Plaque-RADS 3c (OR=2.29) and Plaque-RADS 3ab (OR=2.26) were more linked to stroke than Plaque-RADS 2 (OR=0.5). Conclusions Presence of noninvasively detected unstable plaque characteristics was associated with two-fold higher stroke risk in symptomatic patients. Thrombus and ruptured fibrous cap were the highest-risk features overall; ulceration was the highest-risk feature among non-stenotic plaques in ESUS. Conflict of interest All authors: nothing to disclose. Figure 1 - belongs to Results
Pakizer et al. (Fri,) conducted a meta-analysis in Extracranial carotid atherosclerosis (n=2,430). Non-invasively detected unstable plaque characteristics vs. Stable plaque characteristics / asymptomatic carotid was evaluated on Recent ischemic cerebrovascular events (stroke) (OR 7.21, 95% CI 3.05-17.05). Non-invasively detected unstable carotid plaque characteristics, particularly intraluminal thrombus (OR 7.21; 95% CI 3.05-17.05), were associated with a higher risk of stroke in symptomatic patients.
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