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Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis.

TitlePlaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2015
AuthorsGupta A, Kesavabhotla K, Baradaran H, Kamel H, Pandya A, Giambrone AE, Wright D, Pain KJ, Mtui EE, Suri JS, Sanelli PC, Mushlin AI
JournalStroke
Volume46
Issue1
Pagination91-7
Date Published2015 Jan
ISSN1524-4628
KeywordsAsymptomatic Diseases, Carotid Artery Diseases, Carotid Stenosis, Humans, Plaque, Atherosclerotic, Risk Assessment, Stroke, Ultrasonography
Abstract

BACKGROUND AND PURPOSE: Ultrasonographic plaque echolucency has been studied as a stroke risk marker in carotid atherosclerotic disease. We performed a systematic review and meta-analysis to summarize the association between ultrasound-determined carotid plaque echolucency and future ipsilateral stroke risk.

METHODS: We searched the medical literature for studies evaluating the association between carotid plaque echolucency and future stroke in asymptomatic patients. We included prospective observational studies with stroke outcome ascertainment after baseline carotid plaque echolucency assessment. We performed a meta-analysis and assessed study heterogeneity and publication bias. We also performed subgroup analyses limited to patients with stenosis ≥50%, studies in which plaque echolucency was determined via subjective visual interpretation, studies with a relatively lower risk of bias, and studies published after the year 2000.

RESULTS: We analyzed data from 7 studies on 7557 subjects with a mean follow-up of 37.2 months. We found a significant positive relationship between predominantly echolucent (compared with predominantly echogenic) plaques and the risk of future ipsilateral stroke across all stenosis severities (0% to 99%; relative risk, 2.31; 95% confidence interval, 1.58-3.39; P<0.001) and in subjects with ≥50% stenosis (relative risk, 2.61; 95% confidence interval, 1.47-4.63; P=0.001). A statistically significant increased relative risk for future stroke was preserved in all additional subgroup analyses. No statistically significant heterogeneity or publication bias was present in any of the meta-analyses.

CONCLUSIONS: The presence of ultrasound-determined carotid plaque echolucency provides predictive information in asymptomatic carotid artery stenosis beyond luminal stenosis. However, the magnitude of the increased risk is not sufficient on its own to iden tify patients likely to benefit from surgical revascularization.

DOI10.1161/STROKEAHA.114.006091
Alternate JournalStroke
PubMed ID25406150
PubMed Central IDPMC4280234
Grant ListTL1 TR000459 / TR / NCATS NIH HHS / United States
UL1 RR024996 / RR / NCRR NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States
Category: 
Faculty Publication