背景:颈动脉斑块特征对颈动脉内膜切除术(CEA)后无症状卒中(SS)的预测价值尚不清楚。
目的:探讨CEA患者颈动脉斑块特征与术后SS的关系。
方法:前瞻性。
方法:一百五十三名患者(平均年龄:65.4±7.9岁;126名男性)患有单侧中度至重度颈动脉狭窄(通过CT血管造影评估)的CEA。
■3T,脑MRI:T2-PROPELLER,T1-/T2-FLAIR,弥散加权成像(DWI)和T2*,颈动脉MRI:黑血T1-/T2W,3DTOF,同时非造影血管造影斑块内出血。
结果:患者在CEA前1周内接受颈动脉MRI检查,CEA前/后48小时内脑MRI。存在和大小(体积,最大面积百分比)颈动脉富脂坏死核心(LRNC),在颈动脉-MR图像上评估斑块内出血(I型/II型IPH)和钙化.根据CEA前/后的脑DWI评估术后SS。将患者分为中度颈动脉狭窄(50%-69%)和重度颈动脉狭窄(70%-99%)组,并分析颈动脉斑块特征与SS之间的相关性。
方法:独立t检验,Mann-WhitneyU-test,卡方检验和逻辑回归(OR:赔率比,CI:置信区间)。P值<0.05被认为具有统计学意义。
结果:在49例中度颈动脉狭窄患者中发现8例(16.3%)SS,在104例重度颈动脉狭窄患者中发现21例(20.2%)SS。在严重颈动脉狭窄的患者中,SS患者的IPH明显更高(66.7%vs.39.8%)和I型IPH(66.7%vs.38.6%)比没有的。IPH(OR3.030,95%CI1.106-8.305)和I型IPH(OR3.187,95%CI1.162-8.745)的存在与SS显着相关。调整后,SS与IPH(OR3.294,95%CI1.122-9.669)和I型IPH(OR3.633,95%CI1.216-10.859)的相关性仍然显著.此外,II型IPH的体积(OR1.014,95%CI1.001-1.028),II型IPH(OR1.070,95%CI1.002-1.142)和LRNC(OR1.030,95%CI1.000-1.061)的最大面积百分比与调整后的SS显着相关。在中度颈动脉狭窄患者中,颈动脉斑块特征与SS之间没有显着关联(P范围:0.203-0.980)。
结论:在单侧重度颈动脉狭窄患者中,颈动脉易损斑块MR特征,特别是IPH的存在和大小,可能是CEA后SS的有效预测因子。
方法:2技术效果:阶段2。
BACKGROUND: The predictive value of carotid plaque characteristics for silent stroke (SS) after carotid endarterectomy (CEA) is unclear.
OBJECTIVE: To investigate the associations between carotid plaque characteristics and postoperative SS in patients undergoing CEA.
METHODS: Prospective.
METHODS: One hundred fifty-three patients (mean age: 65.4 ± 7.9 years; 126 males) with unilateral moderate-to-severe carotid stenosis (evaluated by CT angiography) referred for CEA.
UNASSIGNED: 3 T, brain-MRI:T2-PROPELLER, T1-/T2-FLAIR, diffusion weighted imaging (DWI) and T2*, carotid-MRI:black-blood T1-/T2W, 3D TOF, Simultaneous Non-contrast Angiography intraplaque hemorrhage.
RESULTS: Patients underwent carotid-MRI within 1-week before CEA, and brain-MRI within 48-hours pre-/post-CEA. The presence and size (volume, maximum-area-percentage) of carotid lipid-rich necrotic core (LRNC), intraplaque hemorrhage (Type-I/Type-II IPH) and calcification were evaluated on carotid-MR images. Postoperative SS was assessed from pre-/post-CEA brain DWI. Patients were divided into moderate-carotid-stenosis (50%-69%) and severe-carotid-stenosis (70%-99%) groups and the associations between carotid plaque characteristics and SS were analyzed.
METHODS: Independent t test, Mann-Whitney U-test, chi-square test and logistic regressions (OR: odds ratio, CI: confidence interval). P value <0.05 was considered statistically significant.
RESULTS: SS was found in 8 (16.3%) of the 49 patients with moderate-carotid-stenosis and 21 (20.2%) of the 104 patients with severe-carotid-stenosis. In patients with severe-carotid-stenosis, those with SS had significantly higher IPH (66.7% vs. 39.8%) and Type-I IPH (66.7% vs. 38.6%) than those without. The presence of IPH (OR 3.030, 95% CI 1.106-8.305) and Type-I IPH (OR 3.187, 95% CI 1.162-8.745) was significantly associated with SS. After adjustment, the associations of SS with presence of IPH (OR 3.294, 95% CI 1.122-9.669) and Type-I IPH (OR 3.633, 95% CI 1.216-10.859) remained significant. Moreover, the volume of Type-II IPH (OR 1.014, 95% CI 1.001-1.028), and maximum-area-percentage of Type-II IPH (OR 1.070, 95% CI 1.002-1.142) and LRNC (OR 1.030, 95% CI 1.000-1.061) were significantly associated with SS after adjustment. No significant (P range: 0.203-0.980) associations were found between carotid plaque characteristics and SS in patients with moderate-carotid-stenosis.
CONCLUSIONS: In patients with unilateral severe-carotid-stenosis, carotid vulnerable plaque MR features, particularly presence and size of IPH, might be effective predictors for SS after CEA.
METHODS: 2 TECHNICAL EFFICACY: Stage 2.