Highlights
- •Carotid atherosclerosis is associated with an increased risk of stroke in patients with atrial fibrillation (AF).
- •Aortic plaque alone does not predict incident ischemic stroke in patients with AF.
- •Carotid intima-media thickness and characteristics of carotid and aortic plaques might improve stroke prediction in patients with AF.
- •The benefit of these imaging features in improving stroke prediction in patients with AF needs to be evaluated.
Abstract
Objective
This review aimed to summarize the evidence on the risk of thromboembolism associated
with carotid and aortic atherosclerosis in patients with AF, and the potential impact
of their inclusion in current stroke risk stratification scores.
Methods
MEDLINE, Web of Science and EMBASE were systematically searched to identify all published
studies providing relevant data through 28 February 2021.
Results
We identified 10 eligible studies. There was high heterogeneity across studies, precluding
a meta-analysis. Carotid stenosis was not associated with incident ischemic stroke
in three prospective studies, including the SPAF II trial and the ROCKET-AF trial.
An association between carotid stenosis and thromboembolism was found in two studies,
with a potential reporting bias due to their retrospective design. The evidence suggesting
that carotid plaque predicts stroke or transient ischemic attack in AF patients were
more consistent in the four studies evaluating this association. The inclusion of
carotid plaque and carotid intima-media thickness (cIMT) into stroke risk stratification
tools for AF patients improved their performance. Data on the association of aortic
plaque with thromboembolism is scarce in patients with AF. The two studies reporting
on this association suggest that aortic plaque alone does not predict incident ischemic
stroke.
Conclusion
Available data suggest an association of carotid atherosclerosis with the risk of
stroke and transient ischemic attack in patients with AF. Future studies should evaluate
whether incorporating cIMT and characteristics of carotid and aortic plaques into
scoring systems would improve stroke prediction and prevention in patients with AF.
Keywords
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Article info
Publication history
Published online: April 10, 2021
Accepted:
April 8,
2021
Received in revised form:
March 28,
2021
Received:
February 27,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
