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

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

doi:10.1016/j.jcmg.2019.03.028

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

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

Authors

Andreas Schindler

Regina Schinner

Nishaf Altaf

Akram A. Hosseini

Richard J. Simpson

Lorena Esposito-Bauer

Navneet Singh

Robert M. Kwee

Yoshitaka Kurosaki

Sen Yamagata

Kazumichi Yoshida

Susumu Miyamoto

Robert Maggisano

Alan R. Moody

Holger Poppert

M. Eline Kooi

DOROTHEE AUER dorothee.auer@nottingham.ac.uk
Professor of Neuroimaging

Leo H. Bonati

Tobias Saam

Contributors

DOROTHEE AUER dorothee.auer@nottingham.ac.uk
Researcher

Abstract

Objectives
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.

Background
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.

Methods
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.

Results
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% (

Citation

Schindler, A., Schinner, R., Altaf, N., Hosseini, A. A., Simpson, R. J., Esposito-Bauer, L., …Saam, T. (2019). Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques: Meta-Analysis of Individual Patient Data. JACC: Cardiovascular Imaging, 13(2), 395-406. https://doi.org/10.1016/j.jcmg.2019.03.028

Journal Article Type	Article
Acceptance Date	Mar 24, 2019
Online Publication Date	Jun 12, 2019
Publication Date	Jun 12, 2019
Deposit Date	Jun 27, 2019
Publicly Available Date	Jul 1, 2019
Journal	JACC: Cardiovascular Imaging
Print ISSN	1936-878X
Electronic ISSN	1876-7591
Publisher	Elsevier
Peer Reviewed	Peer Reviewed
Volume	13
Issue	2
Pages	395-406
DOI	https://doi.org/10.1016/j.jcmg.2019.03.028
Keywords	Carotid; Cerebrovascular event; Intraplaque hemorrhage; Ischemic stroke; Magnetic resonance imaging; NASCET
Public URL	https://nottingham-repository.worktribe.com/output/2232506
Publisher URL	https://www.sciencedirect.com/science/article/pii/S1936878X19304371?via%3Dihub