Prognostic Role of Carotid Plaque MRI Features in Cerebrovascular Accidents: A Systematic Review and Meta-analysis.

BACKGROUND

Characteristics of carotid plaques reported by magnetic resonance imaging (MRI) has been recently used to predict cerebrovascular accidents (CVA). We conducted this systematic review and meta-analysis to summarize the association of MRI-reported intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent CVAs.

METHODS

Comprehensive search was performed in PubMed, Scopus, and Web of Science databases from inception to September 19, 2024. We included cohort studies evaluating IPH, LRNC, and TRFC carotid plaques with the mean follow-up of ≥1 month, and outcome of the first stroke or transient ischemic attack. A random effect model with assessment of study heterogeneity and publication bias was applied.

RESULTS

Of 5342 studies screened, 13 articles with a total subject of 2729 met the eligibility for systematic review. The hazard ratios (HR) for IPH, LRNC, and TRFC as predictors of CVA were 4.64 (95 % confidence interval (CI), 3.31-6.5), 2.89 (95 % CI, 1.5-5.57), 5.02 (95 % CI, 2.8-8.99), respectively. This demonstrates a significant association between these MRI features and an increased risk of CVA. The subgroup analysis showed no significant difference between the asymptomatic and the symptomatic groups. No significant heterogeneity was found in the meta-analyses.

CONCLUSIONS

The presence of IPH, LRNC, and TRFC on MRI reports of carotid plaques are significant predictors of cerebral ischemic events beyond measurement of luminal stenosis. MRI could identify at risk patients who might benefit from revascularization.