Plaque Echolucency and Stroke Risk in Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis | Journal Scan

Study Questions:

What is the association between ultrasound-determined carotid plaque echolucency and future ipsilateral stroke risk?


In this meta-analysis, the authors included studies with ultrasound characterization of carotid artery plaque echolucency in subjects subsequently followed for development of future ipsilateral stroke.


The authors analyzed data from seven studies (n = 7,557 subjects, mean follow-up = 37.2 months). There was a positive relationship between plaque echolucency and the risk of future ipsilateral stroke with a random-effects relative risk of 2.31 (95% confidence interval [CI], 1.58-3.39; p < 0.001). In the subgroup of patients with >50% carotid stenosis, the positive relationship between plaque echolucency and the risk of future ipsilateral stroke persisted with a random-effects relative risk of 2.61 (95% CI, 1.47-4.63; p = 0.001).


In patients with asymptomatic carotid artery stenosis, the presence of carotid-plaque echolucency provides predictive information about the risk of ipsilateral stroke beyond that offered by luminal stenosis alone.


This is an interesting study that draws attention to ultrasound-determined plaque echolucency as a marker predictive of future ipsilateral stroke risk. As the authors caution, ‘Although nearly 30% of subjects with >50% stenosis demonstrate plaque echolucency, given the low absolute risk in these patients, plaque echolucency alone is not a powerful enough risk factor to select asymptomatic stenosis patients likely to benefit from carotid endarterectomy or stenting.’

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: Carotid Stenosis, Constriction, Pathologic, Endarterectomy, Carotid, Plaque, Atherosclerotic, Risk, Stents, Stroke

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