The following is a summary of “Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review,” published in the November 2023 issue of Cardiology by Sakai et al.
Cryptogenic stroke (CS) patients often exhibit complex aortic plaque (CAP), a potential source of embolism. This review investigates CAP imaging criteria, focusing on transesophageal echocardiogram (TEE), computed tomography angiography (CTA), and magnetic resonance imaging, aiming to assess the prevalence of CAP in acute CS cases. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline, a thorough search of PubMed and EMBASE databases up to December 2022 was conducted. Data extracted from 45 studies encompassed study design, imaging techniques, CAP criteria, and prevalence.
Assessment of risk of bias and reporting completeness was performed using the Cochrane Collaboration tool and Guideline for Reporting Reliability and Agreement Studies, respectively. Among the studies reviewed (37 TEE, 9 CTA, and 6 magnetic resonance imaging), about 74% utilized ≥4 mm plaque thickness as the primary criterion for CAP, although other thresholds like ≥1 mm (CTA), ≥5 mm, and ≥6 mm (TEE) were also reported.
Additional features included mobility, ulceration, thrombus, protrusions, and plaque composition assessment. Among 23 prospective studies, 960 out of 2778 CS patients showed CAP (prevalence: 0.32 [95% CI, 0.24–0.41], I2=94%). By modality, the prevalence estimates were 0.29 (TEE), 0.23 (CTA), and 0.22 (magnetic resonance imaging) with significant heterogeneity (I2=87–95%). The review highlighted TEE as the primary tool for assessing CAP in CS patients and underscored the prevalence of ≥4 mm plaque thickness as a common imaging biomarker. However, substantial heterogeneity across studies emphasizes the necessity for standardized and reproducible imaging methods in future research endeavors.
Source: ahajournals.org/doi/10.1161/JAHA.123.031797
