From the Departments of Clinical Neurosciences (N.S., M.M., J.M.O., M.G., M.A.), and Diagnostic Imaging (M.G., M.A.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
From the Departments of Clinical Neurosciences (N.S., M.M., J.M.O., M.G., M.A.), and Diagnostic Imaging (M.G., M.A.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.
AJNR Am J Neuroradiol. 2020 Aug;41(8):1453-1459. doi: 10.3174/ajnr.A6613. Epub 2020 Jul 9.
Severe carotid stenosis carries a high risk of stroke. However, the risk of stroke with nonstenotic carotid plaques (<50%) is increasingly recognized.
We aimed to summarize the risk of TIA or stroke in patients with nonstenotic carotid plaques.
We performed a comprehensive systematic review and meta-analysis in patients with acute ischemic stroke in whom carotid imaging was performed using MEDLINE and the Cochrane Database, including studies published up to December 2019.
Included studies had >10 patients with <50% carotid plaques on any imaging technique and reported the incidence or recurrence of ischemic stroke/TIA. High-risk plaque features and the risk of progression to stenosis >50% were extracted if reported.
We identified 31 studies reporting on the risk of ipsilateral stroke/TIA in patients with nonstenotic carotid plaques. Twenty-five studies ( = 13,428 participants) reported on first-ever stroke/TIA and 6 studies ( = 122 participants) reported on the recurrence of stroke/TIA.
The incidence of first-ever ipsilateral stroke/TIA was 0.5/100 person-years. The risk of recurrent stroke/TIA was 2.6/100 person-years and increased to 4.9/100 person-years if intraplaque hemorrhage was present. The risk of progression to severe stenosis (>50%) was 2.9/100 person-years (8 studies, = 448 participants).
Included studies showed heterogeneity in reporting stroke etiology, the extent of stroke work-up, imaging modalities, and classification systems used for characterizing carotid stenosis.
The risk of recurrent stroke/TIA in nonstenotic carotid plaques is not negligible, especially in the presence of high-risk plaque features. Further research is needed to better define the significance of nonstenotic carotid plaques for stroke etiology.
严重的颈动脉狭窄会带来很高的中风风险。然而，非狭窄性颈动脉斑块（<50%）的中风风险也越来越受到关注。
我们旨在总结非狭窄性颈动脉斑块患者发生短暂性脑缺血发作（TIA）或中风的风险。
我们对使用 MEDLINE 和 Cochrane 数据库进行颈动脉成像的急性缺血性中风患者进行了全面的系统评价和荟萃分析，包括截至 2019 年 12 月发表的研究。
纳入的研究中，在任何影像学技术上都有超过 10 名患者存在<50%的颈动脉斑块，并报告了缺血性中风/TIA 的发生率或复发率。如果有报道，我们还提取了高危斑块特征和进展为>50%狭窄的风险。
我们共确定了 31 项研究，这些研究报告了非狭窄性颈动脉斑块患者同侧中风/TIA 的风险。25 项研究（ = 13428 名参与者）报告了首次中风/TIA，6 项研究（ = 122 名参与者）报告了中风/TIA 的复发。
首次同侧中风/TIA 的发生率为 0.5/100 人年。复发中风/TIA 的风险为 2.6/100 人年，如果存在斑块内出血，则增加至 4.9/100 人年。进展为严重狭窄（>50%）的风险为 2.9/100 人年（8 项研究， = 448 名参与者）。
纳入的研究在报告中风病因、中风评估程度、影像学模式以及用于描述颈动脉狭窄的分类系统方面存在异质性。
非狭窄性颈动脉斑块患者发生复发中风/TIA 的风险不容忽视，尤其是在存在高危斑块特征的情况下。需要进一步研究以更好地确定非狭窄性颈动脉斑块对中风病因的意义。
