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

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 7; pp. 1594 - 1601
• Main Authors: Finn, Caitlin, BS, Giambrone, Ashley E., PhD, Gialdini, Gino, MD, Delgado, Diana, MLS, Baradaran, Hediyeh, MD, Kamel, Hooman, MD, Gupta, Ajay, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2017
• Subjects: Asymptomatic Diseases; Brain Infarction - diagnostic imaging; Brain Infarction - etiology; Cardiovascular; Carotid atherosclerosis; Carotid Intima-Media Thickness; carotid stenosis; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Humans; intima–media thickness; Magnetic Resonance Imaging; Neurology; Odds Ratio; Prognosis; Risk Assessment; Risk Factors; Severity of Illness Index; silent brain infarction; stroke; intima–media thickness; silent brain infarction; carotid stenosis; Carotid atherosclerosis; stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.028

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; P  < .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; P  < .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.