Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis

BACKGROUND: CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features. PURPOSE: Our aim was to evaluate the association between specific carotid plaque features on CTA and ipsilateral cerebrovascular ischemia. DATA SOURCES: We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library from inception to March 2016 for articles that evaluated the relationship between CTA-detected carotid plaque features and ischemic events, defined as ipsilateral ischemic stroke or transient ischemic attack. STUDY SELECTION: Sixteen studies were ultimately included after screening 12,557. DATA ANALYSIS: Two readers recorded data from each study and assessed the study quality with all disagreements resolved by a third reader. A random-effects OR was used to evaluate the association between cerebrovascular ischemia and each of the evaluated plaque features. DATA SYNTHESIS: We found significant positive relationships with cerebrovascular ischemia for the presence of soft plaque (OR, 2.9; 95% CI, 1.4–6.0), plaque ulceration (OR, 2.2; 95% CI, 1.4–3.4), and increased common carotid artery wall thickness (OR, 6.2; 95% CI, 2.5–15.6). We found a significant negative relationship between calcified plaque and ipsilateral ischemia (OR, 0.5; 95% CI, 0.4–0.7). LIMITATIONS: We found heterogeneity in the existing literature secondary to lack of standardized plaque features and clinical definitions. CONCLUSIONS: Soft plaque, plaque ulceration, and increased common carotid artery wall thickness on CTA are associated with ipsilateral cerebrovascular ischemia, while calcified plaque is negatively associated with downstream ischemic events.

[1]  H. Kamel,et al.  Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis , 2016, Stroke.

[2]  M. E. Kooi,et al.  Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK) , 2015, American Journal of Neuroradiology.

[3]  P-Y Zhou,et al.  Study on the carotid atherosclerotic plaque of patients suffering from ischemic cerebrovascular disease by 64 slices CT. , 2015, European review for medical and pharmacological sciences.

[4]  H. Kamel,et al.  Magnetic Resonance Angiography Detection of Abnormal Carotid Artery Plaque in Patients With Cryptogenic Stroke , 2015, Journal of the American Heart Association.

[5]  H. Kamel,et al.  Detection of Symptomatic Carotid Plaque Using Source Data from MR and CT Angiography: A Correlative Study , 2015, Cerebrovascular Diseases.

[6]  H. Kamel,et al.  CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis , 2015, American Journal of Neuroradiology.

[7]  Jasjit S. Suri,et al.  Plaque Echolucency and Stroke Risk in Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis , 2015, Stroke.

[8]  M. Reiser,et al.  Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques , 2014, Journal of Cardiovascular Magnetic Resonance.

[9]  A. Dunning,et al.  Evaluation of Computed Tomography Angiography Plaque Thickness Measurements in High-Grade Carotid Artery Stenosis , 2014, Stroke.

[10]  M. Reiser,et al.  CTA for Screening of Complicated Atherosclerotic Carotid Plaque—American Heart Association Type VI Lesions as Defined by MRI , 2013, American Journal of Neuroradiology.

[11]  Pina C. Sanelli,et al.  Carotid Plaque MRI and Stroke Risk: A Systematic Review and Meta-analysis , 2013, Stroke.

[12]  E. Feldmann,et al.  Management Strategies for Asymptomatic Carotid Stenosis , 2013, Annals of Internal Medicine.

[13]  M. Wintermark,et al.  Clinical Risk Factors and CT Imaging Features of Carotid Atherosclerotic Plaques as Predictors of New Incident Carotid Ischemic Stroke: A Retrospective Cohort Study , 2013, American Journal of Neuroradiology.

[14]  M. E. Kooi,et al.  Longitudinal MRI Study on the Natural History of Carotid Artery Plaques in Symptomatic Patients , 2012, PloS one.

[15]  M. Reiser,et al.  Prevalence of nonstenosing, complicated atherosclerotic plaques in cryptogenic stroke. , 2012, JACC. Cardiovascular imaging.

[16]  M. Morikawa,et al.  Assessment of Carotid Plaque Stability Based on the Dynamic Enhancement Pattern in Plaque Components With Multidetector CT Angiography , 2012, Stroke.

[17]  S. Kuroda,et al.  Lumen Morphology in Mild‐to‐Moderate Internal Carotid Artery Stenosis Correlates with Neurological Symptoms , 2011, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[18]  A. Demchuk,et al.  Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease , 2010, American Journal of Neuroradiology.

[19]  R. M. Kwee,et al.  Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. , 2010, Journal of vascular surgery.

[20]  L. Saba,et al.  Multidetector row CT of the brain and carotid artery: a correlative analysis. , 2009, Clinical radiology.

[21]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[22]  R. Gonzalez,et al.  Arterial wall enhancement overlying carotid plaque on CT angiography correlates with symptoms in patients with high grade stenosis. , 2009, Stroke.

[23]  J. Wentzel,et al.  Atherosclerotic Plaque Surface Morphology in the Carotid Bifurcation Assessed With Multidetector Computed Tomography Angiography , 2009, Stroke.

[24]  L. Saba,et al.  Fissured Fibrous Cap of Vulnerable Carotid Plaques and Symptomaticity: Are They Correlated? Preliminary Results by Using Multi-Detector-Row CT Angiography , 2009, Cerebrovascular Diseases.

[25]  E. Vittinghoff,et al.  Carotid plaque computed tomography imaging in stroke and nonstroke patients , 2008, Annals of neurology.

[26]  M. Wintermark,et al.  High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques , 2008, American Journal of Neuroradiology.

[27]  L. Saba,et al.  Carotid artery wall thickness and ischemic symptoms: evaluation using multi-detector-row CT angiography , 2008, European Radiology.

[28]  S. Ibayashi,et al.  Carotid Artery Calcification on Multislice Detector-Row Computed Tomography , 2007, Cerebrovascular Diseases.

[29]  Christopher M Kramer,et al.  Composition of the Stable Carotid Plaque: Insights From a Multidetector Computed Tomography Study of Plaque Volume , 2007, Stroke.

[30]  C Barranco,et al.  Quantification and characterization of carotid calcium with multi-detector CT-angiography. , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[31]  L. Wilkins.  Plaque density on CT, a potential marker of ischemic stroke , 2006, Neurology.

[32]  R. Écochard,et al.  Plaque density on CT, a potential marker of ischemic stroke , 2006, Neurology.

[33]  Mark Fisher,et al.  Carotid Plaque Pathology: Thrombosis, Ulceration, and Stroke Pathogenesis , 2005, Stroke.

[34]  C. Kramer,et al.  Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. , 2005, AJR. American journal of roentgenology.

[35]  Seymour Glagov,et al.  Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. , 2004, Journal of vascular surgery.

[36]  A. Simon,et al.  Intima–media thickness: a new tool for diagnosis and treatment of cardiovascular risk , 2002, Journal of hypertension.

[37]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[38]  A H Davies,et al.  The symptomatic carotid plaque. , 2000, Stroke.