背景:钙化常见于晚期动脉粥样斑块,但其临床意义尚不清楚。本研究旨在评估颈动脉中重度狭窄患者斑块钙化的发生率,并探讨其与同侧缺血的关系。
方法:回顾性研究包括浙江省医院2019年1月至2023年3月在多探测器计算机断层扫描中检测到的178例颈内动脉(pICA)近端狭窄≥50%的患者。斑块钙化特征(钙化厚度、position,type,圆周范围,钙体积和钙评分)和同侧脑血管事件进行分析。
结果:178名患者(平均年龄71.24±10.02岁,79.78%的男性)总体上有224个狭窄的pICA。200/224(89.29%)动脉可见斑块钙化。老年组的钙化率较高。钙化体积(r=0.219,p<0.001)和钙化评分(r=0.230,p<0.001)与年龄相关。非钙化组同侧缺血事件明显多于钙化组(χ2=4.160,p=0.041)。最常见的钙化类型为阳性边缘钙化征(87/200,43.50%),其次是大体积钙化(66/200,33.00%);两者均与缺血事件显着相关(χ2=10.448,p=0.001和χ2=4.552,p=0.033)。钙化位置,厚度,和圆周范围,钙化体积和评分,与缺血事件无关。在多变量分析中,阳性边缘体征(OR=2.795,95CI1.182-6.608,p=0.019)是缺血事件的独立预测因子.
结论:颈动脉近端斑块钙化是常见的,患病率随年龄增长而增加。钙化特征可以预测同侧缺血事件。斑块内的阳性边缘体征是未来缺血事件的高风险因素。
BACKGROUND: Calcification is common in advanced atheromatous plaque, but its clinical significance remains unclear. This study aimed to assess the prevalence of plaque calcification in the moderate-to-severe internal carotid artery stenosis and investigate its relationship with ipsilateral ischemia.
METHODS: The retrospective study included 178 patients detected with proximal internal carotid artery (pICA) stenosis of ≥ 50% on multidetector computed tomography at Zhejiang Hospital from January 2019 to March 2023. Association between plaque calcification characteristics (calcification thickness, position, type, circumferential extent, calcium volume and calcium score) and ipsilateral cerebrovascular events was analyzed.
RESULTS: The 178 patients (mean age 71.24 ± 10.02 years, 79.78% males) had 224 stenosed pICAs overall. Plaque calcification was noted in 200/224 (89.29%) arteries. Calcification rates were higher in older age-groups. Calcification volume (r = 0.219, p < 0.001) and calcification score (r = 0.230, p < 0.001) were correlated with age. Ipsilateral ischemic events were significantly more common in the noncalcification group than in the calcification group (χ2 = 4.160, p = 0.041). The most common calcification type was positive rim sign calcification (87/200, 43.50%), followed by bulky calcification (66/200, 33.00%); both were significantly associated with ischemic events (χ2 = 10.448, p = 0.001 and χ2 = 4.552, p = 0.033, respectively). Calcification position, thickness, and circumferential extent, and calcification volume and score, were not associated with ischemic events. In multivariate analysis, positive rim signs (OR = 2.795, 95%CI 1.182-6.608, p = 0.019) was an independent predictor of ischemic events.
CONCLUSIONS: Plaque calcification in proximal internal carotid artery is common, and prevalence increases with age. Calcification characteristics could be predictive of ipsilateral ischemic events. The positive rim sign within plaque is a high-risk factor for a future ischemic event.