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The Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-analysis.

TitleThe Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-analysis.
Publication TypeJournal Article
Year of Publication2017
AuthorsFinn C, Giambrone AE, Gialdini G, Delgado D, Baradaran H, Kamel H, Gupta A
JournalJ Stroke Cerebrovasc Dis
Volume26
Issue7
Pagination1594-1601
Date Published2017 Jul
ISSN1532-8511
KeywordsAsymptomatic Diseases, Brain Infarction, Carotid Intima-Media Thickness, Carotid Stenosis, Humans, Magnetic Resonance Imaging, Odds Ratio, Prognosis, Risk Assessment, Risk Factors, Severity of Illness Index
Abstract

BACKGROUND: Carotid atherosclerosis is responsible for ~20% of ischemic strokes, but it is unclear whether carotid disease is associated with the presence of downstream silent brain infarction (SBI). We performed a systematic review and meta-analysis to study the relationship between SBI and 2 separate manifestations of carotid atherosclerosis, carotid intima-media thickening (IMT) and luminal stenosis.

METHODS: Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database were searched with an additional search of references and citing articles of target studies. Articles were included if they reported an association between carotid IMT or stenosis and magnetic resonance imaging-defined SBI, excluding SBIs found after carotid intervention.

RESULTS: We pooled 7 studies of carotid IMT reporting on 1469 subjects with SBI and 5102 subjects without SBI. Subjects with SBI had a larger mean IMT than subjects without SBI (pooled standardized mean difference, .37; 95% confidence interval [CI], .23-.51; Pā€‰<ā€‰.0001). We pooled 11 studies of carotid stenosis reporting on 12,347 subjects (2110 subjects with carotid stenosis and 10,237 subjects without carotid stenosis). We found a higher prevalence of SBI among subjects with carotid stenosis (30.4% versus 17.4%). Our pooled random-effects analysis showed a significant positive relationship between carotid stenosis and SBI (odds ratio, 2.78; 95% CI, 2.19-3.52; Pā€‰<ā€‰.0001).

CONCLUSIONS: Two forms of atherosclerotic disease, carotid IMT and stenosis, are both significantly associated with SBI. This review highlights a lack of consistent definitions for carotid disease measures and little evidence evaluating SBI prevalence downstream from carotid stenosis.

DOI10.1016/j.jstrokecerebrovasdis.2017.02.028
Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID28318958
PubMed Central IDPMC5474126
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
KL2 TR000458 / TR / NCATS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States