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Meta-Analysis
. 2021 Jun;31(2):307-313.
doi: 10.1007/s00062-020-00921-2. Epub 2020 Jul 9.

Embolic Stroke of Undetermined Source and Carotid Intraplaque Hemorrhage on MRI : A Systemic Review and Meta-Analysis

Ian T Mark  1 , Deena M Nasr  2 , John Huston  1 , Lucio de Maria  3 , Paolo de Sanctis  3 , Vance T Lehman  1 , Alejandro A Rabinstein  2 , Luca Saba  4 , Waleed Brinjikji  5
Affiliations
Meta-Analysis

Embolic Stroke of Undetermined Source and Carotid Intraplaque Hemorrhage on MRI : A Systemic Review and Meta-Analysis

Ian T Mark et al. Clin Neuroradiol. 2021 Jun.

Abstract

Background: Embolic stroke of undetermined source (ESUS) has traditionally discounted the significance of internal carotid artery stenosis of <50%; however, recent studies have examined the role of carotid artery intraplaque hemorrhage (IPH) as an etiology in nonstenotic carotid arteries. We performed a systemic review of the literature to determine the prevalence of carotid artery IPH on magnetic resonance imaging (MRI) of the vessel wall in patients with ESUS.

Methods: We used PubMed, Epub ahead of print, Ovid MEDLINE in-process and other non-indexed citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane central register of controlled trials, Ovid Cochrane database of systematic reviews and Scopus. Our study consisted of all case series with >10 patients with IPH and ESUS published through October 2018. Additionally, we included 123 patients from an institutional database from 2015-2019. Random effects meta-analysis was used for pooling across studies. Meta-analysis results were expressed as odds ratio (OR) with respective 95% confidence intervals (CI).

Results: A total of 7 studies with 354 patients were included. The mean age was 67.5 years old. The overall prevalence estimate for prevalence of IPH ipsilateral to the ischemic lesion was 25.8% (95% CI 13.1-38.5). The odds of having IPH on the ipsilateral side versus the contralateral side was 6.92 (95% CI 3.04-15.79).

Conclusion: Patients with ESUS have IPH in the carotid artery ipsilateral to the ischemic stroke in 25.8% of cases. Carotid artery vessel wall MRI should be considered as part of the standard work-up in patients with ESUS.

Keywords: Carotid artery; Case series; Ischemia; Magnetic resonance imaging; Stenosis.

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