Age and the risk of new ischemic lesions on diffusion weighted imaging after carotid artery stenting: A systematic review and meta-analysis

Abstract

To perform a systematic review and meta-analysis to show the association between age and the risk of new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) after carotid artery stenting in patients with carotid artery stenosis. We searched PubMed and EMBASE from their dates of inception to March 14, 2019 for eligible studies. Standardized mean difference (SMD) and pooled odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the association between age and new DWI lesions. Sensitivity analysis was performed to detect the possible source of heterogeneity. Twenty-three studies enrolling 2127 patients were included. The incidence of new DWI lesions was 62% in older patients and 41% in younger patient (OR 2.44, 95%CI 1.57-3.79; p < 0.0001). The patients with new DWI lesions were older than those without (SMD 0.24, 95% CI 0.08-0.39; p = 0.003). The risk of new DWI lesions increased by 1.07 per added year (95%CI 1.04-1.11, p < 0.0001). The results remained stable in sensitivity analyses and after adjusting for publication bias. It was concluded that older age was at higher risk of new DWI lesions after stenting in patients with carotid artery stenosis.

Keywords: Age; Carotid artery stenosis; Carotid artery stenting; New DWI lesions.