Rapillo Costanza Maria, Giuricin Alessandro, Sarti Cristina, Nesi Mascia, Marcheselli Simona, Lombardo Ivano, Pascarella Rosario, Zedde Marialuisa, Arba Francesco
Neurology Unit and Stroke Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Milan, Italy.
Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.
Int J Stroke. 2025 Jul;20(6):636-645. doi: 10.1177/17474930251317321. Epub 2025 Feb 13.
Recent evidence suggests a possible role of non-stenotic carotid atherosclerotic plaques in the etiology of embolic stroke of undetermined source (ESUS).
We conducted a systematic review and meta-analysis of prevalence and characteristics of non-stenotic carotid plaques (NSPs) with high-risk features (complicated NSP) in internal carotid artery in unilateral ESUS in the anterior circulation. We searched MEDLINE and Ovid-Embase databases. High-risk features were intraplaque hemorrhage, thickness ⩾ 3 mm, ulceration, and hypodensity. We assessed the risk of bias (RoB), extracted the data, calculated the pooled prevalence and 95% confidence intervals (CI) using Inverse Variance Weighting method, and Random Effect models.
We included 16 studies and 1406 patients with different imaging for NSP assessment (1 ultrasound, 11 computed tomography (CT)-angiography, 4 magnetic resonance (MR) angiography). The RoB was moderate to low in most studies. Definition of complicated NSP differed across studies. The combined prevalence of any complicated NSP was 31% (95% CI = 27-36%) ipsilateral and 14% (95% CI = 9-19%) contralateral to the index stroke, the finding of any high-risk NSP was fourfold higher ipsilateral to the index stroke (OR = 3.63; 95% CI = 2.09-6.33). The prevalence of single high-risk features ipsilateral to ESUS was as follows: 35% (95% CI = 30-41%) for thickness ⩾ 3 mm; 24% (95% CI = 8-39%) for ulceration; 45% (95% CI = -2; 93%) for hypodensity, 16% (95% CI = 5-26%) for intraplaque hemorrhage.
Complicated NSPs are present in around a third of all ESUS, and are four times more frequent ipsilaterally to the index stroke. Our results confirm the possible causal role in ESUS and highlight the need for greater diagnostic uniformity of plaque at risk.
最近的证据表明，非狭窄性颈动脉粥样硬化斑块在不明来源栓塞性卒中（ESUS）的病因中可能起作用。
我们对前循环单侧ESUS患者颈内动脉具有高危特征的非狭窄性颈动脉斑块（NSPs）（复杂NSP）的患病率和特征进行了系统评价和荟萃分析。我们检索了MEDLINE和Ovid-Embase数据库。高危特征包括斑块内出血、厚度≥3mm、溃疡和低密度。我们评估了偏倚风险（RoB），提取数据，使用逆方差加权法和随机效应模型计算合并患病率和95%置信区间（CI）。
我们纳入了16项研究和1406例采用不同影像学方法评估NSP的患者（1例超声检查、11例计算机断层扫描（CT）血管造影、4例磁共振（MR）血管造影）。大多数研究中的RoB为中度至低度。不同研究中复杂NSP的定义不同。任何复杂NSP的合并患病率在索引卒中同侧为31%（95%CI=27-36%），对侧为14%（95%CI=9-19%），任何高危NSP在索引卒中同侧的发现率高4倍（OR=3.63；95%CI=2.09-6.33）。ESUS同侧单一高危特征的患病率如下：厚度≥3mm为35%（95%CI=30-41%）；溃疡为24%（95%CI=8-39%）；低密度为45%（95%CI=-2；93%），斑块内出血为16%（95%CI=5-26%）。
约三分之一的ESUS患者存在复杂NSP，且在索引卒中同侧的发生率高4倍。我们的结果证实了其在ESUS中可能的因果作用，并强调了对有风险斑块进行更统一诊断标准的必要性。
