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

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
• Contract Date: Jun 27, 2019