Extracranial Carotid Plaque Calcification and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis.
Extracranial Carotid Plaque Calcification and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis.
复制标题
颅外颈动脉斑块钙化和脑血管缺血：系统评价和荟萃分析。
DOI：
10.1161/strokeaha.123.042807
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发表时间：
2023
期刊：
影响因子：
8.3
通讯作者：
Gupta,Ajay
中科院分区：
文献类型：
--
作者：
Homssi,Moayad;Saha,Atin;Delgado,Diana;RoyChoudhury,Arindam;Thomas,Charlene;Lin,Matthew;Baradaran,Hediyeh;Kamel,Hooman;Gupta,Ajay
尽管冠状动脉钙化量化是心血管风险评估的既定方法，但颈动脉钙化量化的价值尚不清楚。因此，我们进行了系统回顾和荟萃分析，以评估颅外颈动脉斑块钙化负荷和同侧脑血管缺血事件之间的关联。方法在以下数据库中进行了全面的文献检索：奥维德MEDLINE（R）1946年至2022年7月6日;奥维德Embase 1974年至2022年7月6日;和科克伦图书馆（Wiley）。我们进行了荟萃分析，包括研究者进行了钙化体积，百分比或其他总钙负荷的计算机断层扫描评估，总结在一个单一的连续成像生物标志物，并确定这些功能与同侧中风或短暂性脑缺血发作的发生的相关性研究。与无症状患者相比，缺血性卒中或卒中患者同侧颈动脉钙化与缺血性脑血管事件无显著相关性（相对风险为0.75 [95%CI，0.44-1.28];P=0.29）。当仅限于颈动脉显著狭窄（>50%）的研究时，钙化的存在与缺血性卒中风险降低相关（相对风险为0.56 [95%CI，0.38-0.85];P=0.006）。当分析仅限于非狭窄斑块患者的研究时，同侧缺血性卒中的相对风险增加1.72（[95%CI，1.01-2.91];P=0.04）。亚组荟萃分析的总钙负荷和钙的形态学特征显示，其与缺血性中风的关联强度的变化很大，并表现出显着的heterogeneity.CONCLUSIONSThe存在的钙化在颈动脉斑块赋予降低与同侧缺血性事件的关联，虽然这些结果似乎是有限的颈动脉狭窄程度较高。在临床决策中采用颈动脉钙化测量将需要额外的研究，提供更具重现性和标准化的钙表征方法，并在前瞻性研究中测试这些成像策略。
BACKGROUNDAlthough coronary calcification quantification is an established approach for cardiovascular risk assessment, the value of quantifying carotid calcification is less clear. As a result, we performed a systematic review and meta-analysis to evaluate the association between extracranial carotid artery plaque calcification burden and ipsilateral cerebrovascular ischemic events.METHODSA comprehensive literature search was performed in the following databases: Ovid MEDLINE(R) 1946 to July 6, 2022; OVID Embase 1974 to July 6, 2022; and The Cochrane Library (Wiley). We performed meta-analyses including studies in which investigators performed a computed tomography assessment of calcification volume, percentage, or other total calcium burden summarizable in a single continuous imaging biomarker and determined the association of these features with the occurrence of ipsilateral stroke or transient ischemic attack.RESULTSOur overall meta-analysis consisted of 2239 carotid arteries and 9 studies. The presence of calcification in carotid arteries ipsilateral to ischemic stroke or in stroke patients compared with asymptomatic patients did not demonstrate a significant association with ischemic cerebrovascular events (relative risk of 0.75 [95% CI, 0.44–1.28];P=0.29). When restricted to studies of significant carotid artery stenosis (>50%), the presence of calcification was associated with a reduced risk of ischemic stroke (relative risk of 0.56 [95% CI, 0.38–0.85];P=0.006). When the analysis was limited to studies of patients with mainly nonstenotic plaques, there was an increased relative risk of ipsilateral ischemic stroke of 1.72 ([95% CI, 1.01–2.91];P=0.04). Subgroup meta-analyses of total calcium burden and morphological features of calcium showed wide variability in their strength of association with ischemic stroke and demonstrated significant heterogeneity.CONCLUSIONSThe presence of calcification in carotid plaque confers a reduced association with ipsilateral ischemic events, although these results seem to be limited among carotid arteries with higher degrees of stenosis. Adoption of carotid calcification measures in clinical decision-making will require additional studies providing more reproducible and standardized methods of calcium characterization and testing these imaging strategies in prospective studies.