Conte Matteo, Alalfi Mohammed O, Cau Riccardo, Scicolone Roberta, Chaturvedi Seemant, Virmani Renu, De Rubeis Gianluca, Bos Daniel, Saba Luca
From the University of Padua (M.C.), Padua, Italy.
School of Medicine and Surgery (M.O.A.), University of Bologna, Bologna, Italy.
AJNR Am J Neuroradiol. 2025 Jul 1;46(7):1321-1328. doi: 10.3174/ajnr.A8668.
Intracranial atherosclerosis accounts for approximately 8% of all strokes in Western societies but the influence of arterial calcification on plaque instability is a topic of ongoing debate.
Our purpose is to explore the association between the presence and burden of calcium in atherosclerotic plaques among intracranial arteries with the risk of clinical or silent stroke events through a systematic review and meta-analysis.
Studies from PubMed and Embase investigating intracranial vessel calcification and stroke events were reviewed from inception through May 2024, adhering to PRISMA guidelines.
Eight longitudinal studies involving 7297 adult patients undergoing CT or CTA scans for symptomatic or asymptomatic intracranial atherosclerosis were included.
Pooled odds ratios were calculated to assess the relationship between stroke events and either the presence or burden of intracranial arterial calcification. Quality assessment was conducted using QUADAS-2; overall evidence was established using GRADE system. Meta-analysis was performed using random-effects models.
After adjusting for confounding factors, the presence of intracranial arterial calcification was significantly associated with stroke incidence or recurrence (OR = 1.54; 95% CI 1.06-2.24, < .001). The strength of this association was found to be similar (OR = 1.56; 95% CI 1.11-2.19, < .001). A positive correlation was also found for calcium burden (OR = 1.31; 95% CI, 1.17-1.46; < .001). Heterogeneity was moderate for calcium presence (Q = 13.16 and 9.19; I = 62% and 42.61%, respectively); negligible for burden analysis (Q = 6.01; I = 0.01%).
Despite strict inclusion criteria, heterogeneity and variability in calcium scoring methods across studies were observed. The lack of segment-specific analysis may have limited clinical interpretation.
This meta-analysis demonstrates a weak yet present association between intracranial arterial calcification and stroke events. However, given the high prevalence of calcification in the general population, its role for stroke prediction has limited evidence. Future studies may focus on specific arterial segments and emerging calcification patterns to improve predictive accuracy.
在西方社会，颅内动脉粥样硬化约占所有中风病例的8%，但动脉钙化对斑块不稳定性的影响仍是一个存在争议的话题。
我们的目的是通过系统评价和荟萃分析，探讨颅内动脉粥样硬化斑块中钙的存在和负荷与临床或无症状中风事件风险之间的关联。
检索了从创刊至2024年5月的PubMed和Embase数据库中有关颅内血管钙化和中风事件的研究，遵循PRISMA指南。
纳入了八项纵向研究，共7297例成年患者，这些患者因有症状或无症状的颅内动脉粥样硬化接受了CT或CTA扫描。
计算合并比值比，以评估中风事件与颅内动脉钙化的存在或负荷之间的关系。使用QUADAS-2进行质量评估；使用GRADE系统确定总体证据。采用随机效应模型进行荟萃分析。
在调整混杂因素后，颅内动脉钙化的存在与中风发生率或复发显著相关（OR = 1.54；95%CI 1.06 - 2.24，P <.001）。发现这种关联的强度相似（OR = 1.56；95%CI 1.11 - 2.19，P <.001）。钙负荷也呈正相关（OR = 1.31；95%CI，1.17 - 1.46；P <.001）。钙存在的异质性为中度（Q = 13.16和9.19；I²分别为62%和42.61%）；负荷分析的异质性可忽略不计（Q = 6.01；I² = 0.01%）。
尽管纳入标准严格，但各研究间钙评分方法存在异质性和变异性。缺乏节段特异性分析可能限制了临床解释。
这项荟萃分析表明颅内动脉钙化与中风事件之间存在微弱但确实的关联。然而，鉴于钙化在普通人群中的高患病率，其在中风预测中的作用证据有限。未来的研究可能集中在特定动脉节段和新出现的钙化模式上，以提高预测准确性。
