Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis [EXTRACRANIAL VASCULAR]

BACKGROUND:

CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features.

PURPOSE:

Our aim was to evaluate the association between specific carotid plaque features on CTA and ipsilateral cerebrovascular ischemia.

DATA SOURCES:

We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library from inception to March 2016 for articles that evaluated the relationship between CTA-detected carotid plaque features and ischemic events, defined as ipsilateral ischemic stroke or transient ischemic attack.

STUDY SELECTION:

Sixteen studies were ultimately included after screening 12,557.

DATA ANALYSIS:

Two readers recorded data from each study and assessed the study quality with all disagreements resolved by a third reader. A random-effects OR was used to evaluate the association between cerebrovascular ischemia and each of the evaluated plaque features.

DATA SYNTHESIS:

We found significant positive relationships with cerebrovascular ischemia for the presence of soft plaque (OR, 2.9; 95% CI, 1.4–6.0), plaque ulceration (OR, 2.2; 95% CI, 1.4–3.4), and increased common carotid artery wall thickness (OR, 6.2; 95% CI, 2.5–15.6). We found a significant negative relationship between calcified plaque and ipsilateral ischemia (OR, 0.5; 95% CI, 0.4–0.7).

LIMITATIONS:

We found heterogeneity in the existing literature secondary to lack of standardized plaque features and clinical definitions.

CONCLUSIONS:

Soft plaque, plaque ulceration, and increased common carotid artery wall thickness on CTA are associated with ipsilateral cerebrovascular ischemia, while calcified plaque is negatively associated with downstream ischemic events.