title: Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Ultrasonographic plaque echolucency has been studied as a stroke risk marker in carotid atherosclerotic disease. We performed a systematic review and meta-analysis to summarize the association between ultrasound-determined carotid plaque echolucency and future ipsilateral stroke risk.
  
  
  METHODS
  We searched the medical literature for studies evaluating the association between carotid plaque echolucency and future stroke in asymptomatic patients. We included prospective observational studies with stroke outcome ascertainment after baseline carotid plaque echolucency assessment. We performed a meta-analysis and assessed study heterogeneity and publication bias. We also performed subgroup analyses limited to patients with stenosis ≥50%, studies in which plaque echolucency was determined via subjective visual interpretation, studies with a relatively lower risk of bias, and studies published after the year 2000.
  
  
  RESULTS
  We analyzed data from 7 studies on 7557 subjects with a mean follow-up of 37.2 months. We found a significant positive relationship between predominantly echolucent (compared with predominantly echogenic) plaques and the risk of future ipsilateral stroke across all stenosis severities (0% to 99%; relative risk, 2.31; 95% confidence interval, 1.58-3.39; P<0.001) and in subjects with ≥50% stenosis (relative risk, 2.61; 95% confidence interval, 1.47-4.63; P=0.001). A statistically significant increased relative risk for future stroke was preserved in all additional subgroup analyses. No statistically significant heterogeneity or publication bias was present in any of the meta-analyses.
  
  
  CONCLUSIONS
  The presence of ultrasound-determined carotid plaque echolucency provides predictive information in asymptomatic carotid artery stenosis beyond luminal stenosis. However, the magnitude of the increased risk is not sufficient on its own to iden tify patients likely to benefit from surgical revascularization.
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.). ajg9004@med.cornell.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Kartik
authors.initials: K
authors.lastname: Kesavabhotla
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Hediyeh
authors.initials: H
authors.lastname: Baradaran
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Ankur
authors.initials: A
authors.lastname: Pandya
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Giambrone
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Drew
authors.initials: D
authors.lastname: Wright
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Pain
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Edward E
authors.initials: EE
authors.lastname: Mtui
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Suri
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Pina C
authors.initials: PC
authors.lastname: Sanelli
authors.affiliation: From the Department of Radiology (A.G., K.K., H.B., E.E.M., P.C.S.), Brain and Mind Research Institute (A.G., H.K.), Department of Neurology (H.K.), Department of Healthcare Policy and Research (A.P., A.E.G., P.C.S., A.I.M.), and Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.W., K.J.P.), Weill Cornell Medical College, New York, NY; and Stroke Screening and Monitoring Division, AtheroPoint LLC, Roseville, CA (J.S.S.).
authors.forename: Alvin I
authors.initials: AI
authors.lastname: Mushlin
mesh_terms: D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology*; D014463:Ultrasonography
keywords: carotid stenosis; plaque; risk factor; stroke; ultrasound