Cracking the Code of Calcification: How Presence and Burden among Intracranial Arteries Influence Stroke Incidence and Recurrence.

Matteo Conte, Mohammed O Alalfi, Riccardo Cau, Roberta Scicolone, Seemant Chaturvedi, Renu Virmani, Gianluca De Rubeis, Daniel Bos, Luca Saba
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引用次数: 0

Abstract

Background: Intracranial atherosclerosis accounts for approximately 8% of all strokes in Western societies but the influence of arterial calcification on plaque instability is a topic of ongoing debate.

Purpose: Our purpose is to explore the association between the presence and burden of calcium in atherosclerotic plaques among intracranial arteries with the risk of clinical or silent stroke events through a systematic review and meta-analysis.

Data sources: Studies from PubMed and Embase investigating intracranial vessel calcification and stroke events were reviewed from inception through May 2024, adhering to PRISMA guidelines.

Study selection: Eight longitudinal studies involving 7297 adult patients undergoing CT or CTA scans for symptomatic or asymptomatic intracranial atherosclerosis were included.

Data analysis: Pooled odds ratios were calculated to assess the relationship between stroke events and either the presence or burden of intracranial arterial calcification. Quality assessment was conducted using QUADAS-2; overall evidence was established using GRADE system. Meta-analysis was performed using random-effects models.

Data synthesis: After adjusting for confounding factors, the presence of intracranial arterial calcification was significantly associated with stroke incidence or recurrence (OR = 1.54; 95% CI 1.06-2.24, P < .001). The strength of this association was found to be similar (OR = 1.56; 95% CI 1.11-2.19, P < .001). A positive correlation was also found for calcium burden (OR = 1.31; 95% CI, 1.17-1.46; P < .001). Heterogeneity was moderate for calcium presence (Q = 13.16 and 9.19; I2 = 62% and 42.61%, respectively); negligible for burden analysis (Q = 6.01; I2 = 0.01%).

Limitations: Despite strict inclusion criteria, heterogeneity and variability in calcium scoring methods across studies were observed. The lack of segment-specific analysis may have limited clinical interpretation.

Conclusions: This meta-analysis demonstrates a weak yet present association between intracranial arterial calcification and stroke events. However, given the high prevalence of calcification in the general population, its role for stroke prediction has limited evidence. Future studies may focus on specific arterial segments and emerging calcification patterns to improve predictive accuracy.

破解钙化的密码:颅内动脉的存在和负荷如何影响脑卒中的发病率和复发。
背景:颅内动脉粥样硬化约占西方社会所有中风的8%,但动脉钙化对斑块不稳定性的影响是一个持续争论的话题。目的:通过一项系统综述和荟萃分析,探讨颅内动脉粥样硬化斑块中钙的存在和负荷与临床或无症状卒中事件风险之间的关系。数据来源:遵循PRISMA指南,对PubMed和Embase的研究进行了分析,截止到2024年5月。研究选择:接受CT/CTA扫描颅内血管有症状和无症状动脉粥样硬化的成年人群。资料分析:通过统计分析确定钙的存在和相对负担对卒中发生率或复发的影响。偏倚风险采用QUADAS-2标准评估,证据质量采用GRADE系统评估。数据综合:本研究综合了8项纵向研究的数据,建立了两种不同的模型:钙存在(异质性:Q 9.19;I2 42.61%)和钙负荷(异质性:q6.01;I2 0.01%)。考虑6839例患者钙存在与脑卒中事件的关系,建立两种统计模型。我们的分析在钙的存在和中风事件之间建立了显著的联系。[OR= 1.54, 95% CI 1.06, 2.24, p=0.001]。随后的效应量分析显示相似的相关性强度[OR = 1.56, 95% CI 1.11, 2.19, p = 0.001]。钙负荷与脑卒中事件的关系纳入4885例患者,效应量分析证实两者呈正相关[OR = 1.31, 95% CI, 1.17, 1.46, p =< 0.001]。发现钙含量[OR = 1.56]和负荷[OR = 1.31]与脑卒中事件的相关性减弱。局限性:尽管有严格的排除标准,但本研究的研究之间和不同统计模型之间的异质性仍然存在。被排除的研究中有价值的数据丢失可能影响了本荟萃分析的结果。纳入文献未广泛采用统一的钙评分模式和单独的动脉段分析。结论:我们的荟萃分析显示颅内动脉血管中钙化的存在和负担与临床或无症状脑卒中事件之间存在微弱但存在的关联。考虑到颅内钙化在普通人群中的高患病率,目前广泛的颅内钙化评估用于脑卒中预测的证据不足。研究特定的颅内血管或探索新的钙化模式对于提高钙化在卒中发生率或复发中的预测准确性至关重要。简称:IAC =颅内动脉钙化;Hounsfield单位;RE =随机效应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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