摘要Objective To access the correlations between characteristics of carotid plaque in MRI and ischemic stroke in patients with ≤50% carotid artery stenosis. Methods A total of 43 patients with ≤50% carotid artery stenosis were selected for ultrasound from September 2014 to February 2016. A further test using magnetic resonance (MR) black blood imaging examination were carried out to distinguish the anatomy of the vessel as well the composition of the atherosclerotic plaque with remarkable details. The relationship between carotid plaque characteristics in MRI and other risk factors of patients with ischemic stroke was analyzed by univariate and multivariate analysis. Results The mean follow-up time was 11.8 months. During the follow-up period, 4 of the 43 individuals experienced an ipsilateral ischemic stroke. Kaplan-Meier survival analysis showed the mean ischemic stroke free survival of patients with coronary heart disease (CHD) was significantly shorter than that in patients without CHD, which were 12.1 months and 18.7 months respectively (P=0.029). The mean ischemic stroke free survival of patients with intra-plaque hemorrhage (IPH) was significantly shorter than that in patients without IPH, which were 14.3 months and 18.6 months respectively (P=0.001). COX regression analysis showed that coronary heart disease (HR=27.4; 95% CI, 1.6-464.3; P=0.022) and IPH (HR=18.2; 95% CI, 2.7-123.3; P=0.003) were independent risk factors for ischemic stroke. Conclusion For patients with carotid artery stenosis ≤50%, IPH of carotid plaques and CHD are independent risk factors for ischemic stroke.
Abstract:Objective To access the correlations between characteristics of carotid plaque in MRI and ischemic stroke in patients with ≤50% carotid artery stenosis. Methods A total of 43 patients with ≤50% carotid artery stenosis were selected for ultrasound from September 2014 to February 2016. A further test using magnetic resonance (MR) black blood imaging examination were carried out to distinguish the anatomy of the vessel as well the composition of the atherosclerotic plaque with remarkable details. The relationship between carotid plaque characteristics in MRI and other risk factors of patients with ischemic stroke was analyzed by univariate and multivariate analysis. Results The mean follow-up time was 11.8 months. During the follow-up period, 4 of the 43 individuals experienced an ipsilateral ischemic stroke. Kaplan-Meier survival analysis showed the mean ischemic stroke free survival of patients with coronary heart disease (CHD) was significantly shorter than that in patients without CHD, which were 12.1 months and 18.7 months respectively (P=0.029). The mean ischemic stroke free survival of patients with intra-plaque hemorrhage (IPH) was significantly shorter than that in patients without IPH, which were 14.3 months and 18.6 months respectively (P=0.001). COX regression analysis showed that coronary heart disease (HR=27.4; 95% CI, 1.6-464.3; P=0.022) and IPH (HR=18.2; 95% CI, 2.7-123.3; P=0.003) were independent risk factors for ischemic stroke. Conclusion For patients with carotid artery stenosis ≤50%, IPH of carotid plaques and CHD are independent risk factors for ischemic stroke.
通讯作者:
Qian Wang, Department of Vascular Surgery, the First Affiliated Hospital of Tsinghua University, Beijing 100016, China. E-mail address: wangqianeu@126.com
引用本文:
Qian Wang, Sibo Liu, Anni Long, Jingzhe Liu, Xiaowei Zhang, Lei Li. Correlation between Carotid Plaque Characteristics without Operative Indication and Ischemic Stroke[J]. 中国生物医学工程学报(英文版), 2020, 29(2): 17-24.
Qian Wang, Sibo Liu, Anni Long, Jingzhe Liu, Xiaowei Zhang, Lei Li. Correlation between Carotid Plaque Characteristics without Operative Indication and Ischemic Stroke. Chinese Journal of Biomedical Engineering, 2020, 29(2): 17-24.
[1] Zhao Dong. Epidemiological study on incidence rate and mortality of stroke in Chinese population[J].Chinese Journal of Epidemiology, 2003,24(3):236-239. [Publication in Chinese] [2] North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) . Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J].N Engl J Med,1991,325:445. [3] Miao Dongpei, Lyu Lei, Yin Yugang, et al. Preliminary analysis of the relationship between carotid atherosclerosis and ischemic cerebral infarction in the elderly[J].International Journal of Cerebrovascular Disease, 2008,16(1):17-20. [Publication in Chinese] [4] Xie Jian, Zhang Chengguo, Shao Yan. Relationship between blood lipid, carotid atherosclerosis and ischemic cerebrovascular disease[J].Chinese Journal of Cerebrovascular Disease (Electronic Edition), 2008,8:250-253.[Publication in Chinese] [5] Cao Maohong, Ke Kaifu, Zhou Ranran,et al.Carotid plaque and related factors in patients with cerebral infarction[J].Chinese Journal of Geriatric Cardio Cerebrovascular Disease, 2011,13(1):62-64.[Publication in Chinese] [6] Barnett HJ, Taylor DW, Eliasziw M,et al.Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators[J].N Engl J Med, 1998,339:1415-1425. [7] Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST)[J].Lancet, 1998,351:1379-1387. [8] Brott TG, Hobson RW, Howard G,et al.Stenting versus endarterectomy for treatment of carotid-artery stenosis[J].N Engl J Med, 2010,363:11-23. [9] Ricotta JJ, Aburahma A, Ascher E,et al.Updated society for vascular surgery guidelines for management of extracranial carotid disease[J].J Vasc Surg,2011,54(3):832-836. [10] Brinjikji W, Huston J, Rabinstein AA,et al.Contemporary carotid imaging: from degree of stenosis to plaque vulnerability[J].J Neurosurg, 2016,124(1):27-42. [11] Alberto C, Fausto C, Gioel GS,et al.Carotid artery stenting: an update[J].European Heart Journal, 2015,36:13-21. [12] Fuster V, Stein B, Ambrose JA,et al.Atherosclerotic plaque rupture and thrombosis. Evolving concepts[J].Circulation, 1990,82:II47-II59. [13] Watanabe Y, Nagayama M, Suga T,et al.Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US)[J].J Magn Reson Imaging, 2008,28(2):478-485. [14] Polak JF, Shemanski L, O’Leary DH,et al.Hypoechoic plaque at us of the carotid artery: An independent risk factor for incident stroke in adults aged 65 years or older[J].Cardiovascular Health Study. Radiology, 1998,208:649-654. [15] Gronholdt ML, Nordestgaard BG, Schroeder TV,et al.Ultrasonic echolucent carotid plaques predict future strokes[J]. Circulation, 2001,104:68-73. [16] Mathiesen EB, Bonaa KH, Joakimsen O. Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis: the troms study[J].Circulation, 2001,103(17):2171-2175. [17] Owolabi MO, Akpa OM, Agunloye AM. Carotid IMT is more associated with stroke than risk calculators[J].Acta Neurol Scand, 2016,133: 442-450. [18] Nakamura T,Tsutsumi Y,Shimizu Y,et al.Ulcerated carotid plaques with ultrasonic echolucency are causatively associated with thromboembolic cerebrovascular events[J]. J Stroke Cerebrovasc Dis,2013,22(2):93-99. [19] Cai JM, Hatsukami TS, Ferguson MS,et al.Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging[J].Circulation, 2002,106(11):1368-1373. [20] Altaf N, Daniels L, Morgan PS,et al.Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events[J]. J Vasc Surg, 2008,47(2):337-342. [21] Takaya N, Yuan C, Chu B,et al.Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results[J]. Stroke, 2006,37(3):818-823. [22] Lin Kai, Zhang Zhaoqi, LV Biao,et al.The relationship between carotid vulnerable plaque and interval time of recurrent ischemic stroke[J].Chinese Medical Imaging Technology, 2006,22(3): 372-376. [Publication in Chinese] [23] Wang Ji, Zhao Huilin, Cao ye,et al.Relationship between carotid atherosclerosis and acute cerebral infarction detected by magnetic resonance imaging[J].Radiology Practice, 2012,27(12): 1320-1323. [Publication in Chinese] [24] Luo Nan, Liu Yi, fan Zhanming,et al.MRI evaluation of carotid atherosclerotic plaque composition, type and its correlation with clinical symptoms[J].Chinese Journal of Clinicians (Electronic Edition), 2013(23): 10519-10524. [Publication in Chinese] [25] Gupta A, Baradaran H, Schweitzer AD,et al.Carotid plaque MRI and stroke risk: a systematic review and meta-analysis[J]. Stroke, 2013,44(11): 3071-3077. [26] Yoshida K, Sadamasa N, Narumi O,et al.Symptomatic low-grade carotid stenosis with intraplaque hemorrhage and expansive arterial remodeling is associated with a high relapse rate refractory to medical treatment[J]. Neurosurgery,2012,70:1143-1150. [27] Calvet D, Touze E, Varenne O,et al.Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study[J].Circulation, 2010,121(14):1623-1629. [28] Jensen JK, Medina HM, Norgaard BL,et al.Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography[J].Int J Cardiol, 2012,160(3):171-174.