Oxygen Extraction Fraction and Stroke Risk in Patients with Carotid Stenosis or Occlusion: A Systematic Review and Meta-Analysis

Authors

A. Gupta, Weill Cornell Medical College
H. Baradaran, Weill Cornell Medical College
A. D. Schweitzer, Weill Cornell Medical College
H. Kamel, Weill Cornell Medical College
A. Pandya, Weill Cornell Medical College
D. Delgado, Weill Cornell Medical College
D. Wright, Weill Cornell Medical College
Sandra M. Hurtado Rua, Cleveland State UniversityFollow
Y. Wang, Weill Cornell Medical College
P. C. Sanelli, Weill Cornell Medical College

Document Type

Article

Publication Date

2-1-2014

Publication Title

American Journal of Neuroradiology

Abstract

BACKGROUND AND PURPOSE: Increased oxygen extraction fraction on PET has been considered a risk factor for stroke in patients with carotid stenosis or occlusion, though the strength of this association has recently been questioned. We performed a systematic review and meta-analysis to summarize the association between increased oxygen extraction fraction and ipsilateral stroke risk. MATERIALS AND METHODS: A comprehensive literature search was performed. We included studies with baseline PET oxygen extraction fraction testing, ipsilateral stroke as the primary outcome, and at least 1 year of follow-up. A meta-analysis was performed by use of a random-effects model. RESULTS: After screening 2158 studies, 7 studies with 430 total patients with mean 30-month follow-up met inclusion criteria. We found that 6 of 7 studies were amenable to meta-analysis. Although 4 of the 6 studies independently did not reach statistical significance, meta-analysis revealed a significant positive relationship between abnormal oxygen extraction fraction and future ipsilateral stroke, with a pooled OR of 6.04 (95% CI, 2.58–14.12). There was no statistically significant difference in OR in the subgroup analyses according to testing method or disease site. CONCLUSIONS: Abnormal oxygen extraction fraction remains a powerful predictor of stroke in carotid stenosis or occlusion and is a valuable reference standard to compare and validate MR imaging–based measures of brain oxygen metabolism. However, there is a need for further evaluation of oxygen extraction fraction testing in patients with high-grade but asymptomatic carotid disease.

Comments

This paper was supported in part by NIH grant R01EB013443.

Repository Citation

Gupta, A.; Baradaran, H.; Schweitzer, A. D.; Kamel, H.; Pandya, A.; Delgado, D.; Wright, D.; Hurtado Rua, Sandra M.; Wang, Y.; and Sanelli, P. C., "Oxygen Extraction Fraction and Stroke Risk in Patients with Carotid Stenosis or Occlusion: A Systematic Review and Meta-Analysis" (2014). Mathematics and Statistics Faculty Publications. 143.
https://engagedscholarship.csuohio.edu/scimath_facpub/143

DOI

10.3174/ajnr.A3668

Volume

35

Issue

2