Abstract：
OBJECTIVE: The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI).
METHODS: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results.
RESULTS: There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups.
CONCLUSIONS: There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
METHODS: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results.
RESULTS: There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups.
CONCLUSIONS: There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
摘要：
目的：前循环动脉粥样硬化斑块（ACAP）和后循环动脉粥样硬化斑块（PCAP）引起的卒中的临床特征和机制是不同的。我们的目标是比较脆弱性的差异，形态学,基于高分辨率磁共振成像（HR-MRI）的ACAP和PCAP之间的分布。
方法：PubMed，Embase,科克伦图书馆,中国国家知识基础设施(CNKI),和万方数据库从成立到2023年5月检索。Meta分析采用R4.2.1软件进行。文献的质量由医疗保健研究和质量机构(AHRQ)评估。进行亚组分析以探讨合并结果的异质性。
结果：共13篇，包括1194个ACAP和1037个PCAP。汇总的估计值表明，PCAP中斑块内出血的发生率更高（OR1.72，95CI1.35-2.18）。PCAP的斑块长度（SMD0.23，95CI0.06-0.39）和重塑指数（SMD0.29，95CI0.14-0.44）均大于ACAP。然而,两组间的显著强化或狭窄程度无明显差异。
结论：PCAP中有更多不稳定的功能，强调后循环复发性缺血性卒中的风险升高。此外，由于分布较广，PCAP容易发生穿透性动脉疾病。然而，后循环动脉表现出更大的向外重塑倾向，这可能导致治疗团队在血管造影检测中被忽视而错过最佳干预阶段。
方法：PubMed，Embase,科克伦图书馆,中国国家知识基础设施(CNKI),和万方数据库从成立到2023年5月检索。Meta分析采用R4.2.1软件进行。文献的质量由医疗保健研究和质量机构(AHRQ)评估。进行亚组分析以探讨合并结果的异质性。
结果：共13篇，包括1194个ACAP和1037个PCAP。汇总的估计值表明，PCAP中斑块内出血的发生率更高（OR1.72，95CI1.35-2.18）。PCAP的斑块长度（SMD0.23，95CI0.06-0.39）和重塑指数（SMD0.29，95CI0.14-0.44）均大于ACAP。然而,两组间的显著强化或狭窄程度无明显差异。
结论：PCAP中有更多不稳定的功能，强调后循环复发性缺血性卒中的风险升高。此外，由于分布较广，PCAP容易发生穿透性动脉疾病。然而，后循环动脉表现出更大的向外重塑倾向，这可能导致治疗团队在血管造影检测中被忽视而错过最佳干预阶段。
