Calcified carotid artery atheroma and stroke risk assessment. Use of Doppler ultrasonography as a secondary marker: a meta-analysis.

Abstract

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, "Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?" This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography.