Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
J Neurol Sci. 2021 Jun 15;425:117444. doi: 10.1016/j.jns.2021.117444. Epub 2021 Apr 10.
This review aimed to summarize the evidence on the risk of thromboembolism associated with carotid and aortic atherosclerosis in patients with AF, and the potential impact of their inclusion in current stroke risk stratification scores.
MEDLINE, Web of Science and EMBASE were systematically searched to identify all published studies providing relevant data through 28 February 2021.
We identified 10 eligible studies. There was high heterogeneity across studies, precluding a meta-analysis. Carotid stenosis was not associated with incident ischemic stroke in three prospective studies, including the SPAF II trial and the ROCKET-AF trial. An association between carotid stenosis and thromboembolism was found in two studies, with a potential reporting bias due to their retrospective design. The evidence suggesting that carotid plaque predicts stroke or transient ischemic attack in AF patients were more consistent in the four studies evaluating this association. The inclusion of carotid plaque and carotid intima-media thickness (cIMT) into stroke risk stratification tools for AF patients improved their performance. Data on the association of aortic plaque with thromboembolism is scarce in patients with AF. The two studies reporting on this association suggest that aortic plaque alone does not predict incident ischemic stroke.
Available data suggest an association of carotid atherosclerosis with the risk of stroke and transient ischemic attack in patients with AF. Future studies should evaluate whether incorporating cIMT and characteristics of carotid and aortic plaques into scoring systems would improve stroke prediction and prevention in patients with AF.
本综述旨在总结房颤患者颈动脉和主动脉粥样硬化与血栓栓塞风险的相关证据，以及将其纳入目前卒中风险分层评分的潜在影响。
系统检索 MEDLINE、Web of Science 和 EMBASE 数据库，以获取截至 2021 年 2 月 28 日发表的所有提供相关数据的研究。
我们共纳入了 10 项符合条件的研究。由于研究间存在高度异质性，因此无法进行荟萃分析。三项前瞻性研究表明颈动脉狭窄与缺血性卒中的发生无关，包括 SPAF II 试验和 ROCKET-AF 试验。两项研究发现颈动脉狭窄与血栓栓塞之间存在关联，但由于其回顾性设计，存在潜在的报告偏倚。四项评估该相关性的研究中，颈动脉斑块预测房颤患者卒中或短暂性脑缺血发作的证据更为一致。将颈动脉斑块和颈动脉内膜中层厚度（cIMT）纳入房颤患者的卒中风险分层工具可提高其性能。关于主动脉斑块与血栓栓塞的相关性在房颤患者中数据较少。两项报告该相关性的研究表明，主动脉斑块本身并不能预测缺血性卒中的发生。
现有数据表明，颈动脉粥样硬化与房颤患者卒中及短暂性脑缺血发作风险相关。未来的研究应评估将 cIMT 以及颈动脉和主动脉斑块特征纳入评分系统是否能改善房颤患者的卒中预测和预防。
