Hediyeh Baradaran MD, Presenter: Nothing to Disclose

Kartik Kesavabhotla, Abstract Co-Author: Nothing to Disclose

Edward E. Mtui MD, Abstract Co-Author: Nothing to Disclose

Diana Delgado MS, Abstract Co-Author: Nothing to Disclose

Ashley Giambrone PhD, Abstract Co-Author: Nothing to Disclose

Ajay Gupta MD, Abstract Co-Author: Nothing to Disclose

Among methods to further risk-stratify patients with asymptomatic carotid stenosis, carotid artery plaque echolucency on ultrasound (US) has been identified as a noninvasive imaging marker for future stroke risk. We performed a systematic review and meta-analysis to evaluate the association between echolucent plaque identified on US and future ischemic events in asymptomatic patients with carotid atherosclerotic disease.

We performed a comprehensive literature search evaluating the association of US-based characterization of carotid plaque with ischemic events. The included studies were prospective observational studies examining plaque echolucency on US in asymptomatic patients with mean follow-up of at least 1 year assessing for development of ipsilateral ischemic event. A meta-analysis with assessment of study heterogeneity and publication bias was performed. Results were summarized using a random or fixed-effects model. 

Of the 5409 manuscripts screened, 7 met eligibility for systematic review and meta-analysis. A total of 7727 patients with a mean age of 72.1 were included. Because no significant heterogeneity was found between studies, a fixed effects model was used. The relative risk (RR) for ipsilateral stroke in patients with echolucent plaque was 3.00 (95% CI, 1.858-4.852; p = 0.00). In a subset analysis, the RR for ipsilateral stroke in patients with >50% carotid artery stenosis and echolucent plaque was 2.56 (95% CI, 1.275-5.137; p = 0.01). No statistically significant publication bias was found between studies. 

In this meta-analysis of 7727 patients, we found that the presence of echolucent plaque on carotid artery US increases the risk of future ipsilateral stroke in asymptomatic patients with carotid atherosclerotic disease.

US imaging routinely acquired for carotid artery stenosis screening can also be used to classify plaque echolucency and potentially offers a simple tool to further risk stratify asymptomatic patients with carotid atherosclerotic disease. 

Baradaran, H, Kesavabhotla, K, Mtui, E, Delgado, D, Giambrone, A, Gupta, A, Plaque Echolucency and Stroke Risk in Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007416.html