Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques: Meta-Analysis of Individual Patient Data

The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging. IPH in carotid stenosis increases the risk of cerebrovascular events. Uncertainty remains whether risk of...

Full description

Saved in:
Bibliographic Details
Published in:JACC. Cardiovascular imaging 2020-02, Vol.13 (2 Pt 1), p.395-406
Main Authors: Schindler, Andreas, Schinner, Regina, Altaf, Nishaf, Hosseini, Akram A, Simpson, Richard J, Esposito-Bauer, Lorena, Singh, Navneet, Kwee, Robert M, Kurosaki, Yoshitaka, Yamagata, Sen, Yoshida, Kazumichi, Miyamoto, Susumu, Maggisano, Robert, Moody, Alan R, Poppert, Holger, Kooi, M Eline, Auer, Dorothee P, Bonati, Leo H, Saam, Tobias
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Asymptomatic Diseases
Brain Ischemia - diagnosis
Brain Ischemia - etiology
Carotid Stenosis - complications
Carotid Stenosis - diagnostic imaging
Female
Hemorrhage - complications
Hemorrhage - diagnostic imaging
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Plaque, Atherosclerotic
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Stroke - diagnosis
Stroke - etiology
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging. IPH in carotid stenosis increases the risk of cerebrovascular events. Uncertainty remains whether risk of stroke alone is increased and whether stroke is predicted independently of known risk factors. Data were pooled from 7 cohort studies including 560 patients with symptomatic carotid stenosis and 136 patients with asymptomatic carotid stenosis. Hazards of ipsilateral ischemic stroke (primary outcome) were compared between patients with and without IPH, adjusted for clinical risk factors. IPH was present in 51.6% of patients with symptomatic carotid stenosis and 29.4% of patients with asymptomatic carotid stenosis. During 1,121 observed person-years, 66 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 10.2; 95% confidence interval [CI]: 4.6 to 22.5) and asymptomatic (HR: 7.9; 95% CI: 1.3 to 47.6) patients. Among patients with symptomatic carotid stenosis, annualized event rates of ipsilateral stroke in those with IPH versus those without IPH were 9.0% versus 0.7% (
ISSN:1876-7591
DOI:10.1016/j.jcmg.2019.03.028