The provided text is a PRISMA checklist and does not contain the quantitative results of the meta-analysis evaluating the association between lipid-rich necrotic core of the carotid plaque and MACCE.
Meta-Analysis
Does the presence and size of lipid-rich necrotic core in carotid plaques increase the risk of major adverse cardiovascular and cerebrovascular events?
The presence and size of a lipid-rich necrotic core in carotid plaques are significant risk factors for major adverse cardiovascular and cerebrovascular events, suggesting it as a potential therapeutic target.
Background Carotid atherosclerosis drives major adverse cardiovascular and cerebrovascular events (MACCEs), but the role of lipid-rich necrotic core (LRNC) remains controversial. We aimed to clarify this via systematic review and meta-analysis. Methods PubMed, Embase, Web of Science, and Cochrane were searched for studies reporting LRNC prevalence or size and MACCEs from inception to March 1, 2026. Study quality was assessed using the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS) tools. Results Our meta-analysis included 18 studies, involving 5,682 patients and 6,257 carotid plaques. Our results showed that in individuals with lipid-core-containing carotid plaques, the cumulative incidence of MACCEs over a mean follow-up of ∼32.2 months (range 3.1–61.2 months) was approximately 7.6% (95% CI 0.059–0.098). When a stroke occurred, the probability of it occurring on the same side as a lipid-core-containing plaque was approximately 58.0% (95% CI 0.427–0.720). Moreover, the presence of a lipid core in carotid plaques was a risk factor for MACCEs, increasing their incidence (HR: 1.570, 95% CI 1.006–2.450; OR: 2.042, 95% CI 1.474–2.828). Compared with patients without MACCEs, those with MACCEs had larger mean LRNC volumes (in mm 3 ) (MD: 8.284 mm 3 , 95% CI 1.353–15.215), larger maximum LRNC volumes (in mm 2 ) (MD: 8.68 mm 2 , 95% CI 4.095–13.265), and a higher proportion of LRNC in the plaque (in %) (MD: 0.471%, 95% CI 0.073–0.868). Additionally, patients with MACCEs had a higher proportion of lipid core volume in the plaque (in %) (MD: 2.283%, 95% CI 0.354–4.211). Conclusions Despite limited studies, LRNC presence and size are MACCE risk factors, suggesting therapeutic targeting prevents MACCEs.
Sun et al. (Wed,) conducted a meta-analysis in Carotid plaque with lipid-rich necrotic core. Lipid-rich necrotic core of the carotid plaque was evaluated on Major adverse cardiovascular and cerebrovascular events. The provided text is a PRISMA checklist and does not contain the quantitative results of the meta-analysis evaluating the association between lipid-rich necrotic core of the carotid plaque and MACCE.