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.

中文翻译：

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MRI 上不明来源的栓塞性卒中和颈动脉斑块内出血：系统评价和荟萃分析。

背景

来源不明的栓塞性卒中 (ESUS) 传统上忽视了<50% 的颈内动脉狭窄的重要性；然而，最近的研究检查了颈动脉斑块内出血 (IPH) 作为非狭窄颈动脉病因的作用。我们对文献进行了系统回顾，以确定 ESUS 患者血管壁磁共振成像 (MRI) 上颈动脉 IPH 的患病率。

方法

我们使用了 PubMed、Epub 印刷前、Ovid MEDLINE 处理中和其他非索引引文、Ovid MEDLINE、Ovid EMBASE、Ovid Cochrane 对照试验中央登记、Ovid Cochrane 系统评价数据库和 Scopus。我们的研究包括截至 2018 年 10 月发表的 >10 名 IPH 和 ESUS 患者的所有病例系列。此外，我们还包括 2015-2019 年机构数据库中的 123 名患者。随机效应荟萃分析用于跨研究汇总。荟萃分析结果以优势比 (OR) 和各自的 95% 置信区间 (CI) 表示。

结果

共纳入 7 项研究，共 354 名患者。平均年龄为 67.5 岁。缺血性病变同侧 IPH 的总体患病率估计为 25.8% (95% CI 13.1-38.5)。同侧与对侧发生 IPH 的几率为 6.92 (95% CI 3.04–15.79)。

结论

25.8% 的 ESUS 患者在缺血性卒中同侧的颈动脉中存在 IPH。颈动脉血管壁 MRI 应被视为 ESUS 患者标准检查的一部分。