Altaf N, Daniels L, Morgan P S, Lowe J, Gladman J, MacSweeney S T, Moody A, Auer D P
Department of Academic Radiology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
Eur J Vasc Endovasc Surg. 2006 Jan;31(1):8-13. doi: 10.1016/j.ejvs.2005.08.026. Epub 2005 Oct 14.
The aim of this study was to determine whether unstable carotid plaques, a known risk factor for cerebral emboli, are associated with cerebral white matter lesions.
Seventy-one symptomatic patients undergoing magnetic resonance imaging prior to carotid endarterectomy for high grade carotid stenosis were included in this study. The number and volume of white matter hyperintense lesions (WMHL) on fluid attenuated inversion recovery brain scans were compared according to the morphology of carotid plaque based upon the American Heart Association (AHA) histological classification.
Of the 57 patients who had good quality brain scans and non-fragmented carotid plaques, 15 plaques were defined as stable (type V) and 42 as unstable (type VI). After adjustment for the major risk factors affecting WMHL, unstable carotid plaques were found to be associated with more WMHL in the ipsilateral cerebral hemisphere than stable plaques (transformed means 2.50+/-1.2 vs. 1.53+/-1.1, p=0.016), however, there was only a trend towards larger WMHL volumes (p=0.079).
The observed association between unstable carotid plaques and the number of white matter lesions suggest that thromboembolic plaque activity may contribute to the development of leukoaraiosis, in particular smaller individual lesions. Larger studies are warranted to confirm this finding and explore the potential clinical impact for selecting candidates for carotid endarterectomy.
本研究旨在确定不稳定颈动脉斑块（已知的脑栓塞危险因素）是否与脑白质病变相关。
本研究纳入了71例因重度颈动脉狭窄在接受颈动脉内膜切除术前行磁共振成像检查的有症状患者。根据美国心脏协会（AHA）组织学分类，依据颈动脉斑块的形态，比较液体衰减反转恢复脑扫描上白质高信号病变（WMHL）的数量和体积。
在57例脑扫描质量良好且颈动脉斑块完整的患者中，15个斑块被定义为稳定型（V型），42个为不稳定型（VI型）。在对影响WMHL的主要危险因素进行校正后，发现不稳定颈动脉斑块与同侧脑半球中比稳定斑块更多的WMHL相关（转换后均值2.50±1.2对1.53±1.1，p = 0.016），然而，WMHL体积仅存在增大趋势（p = 0.079）。
观察到的不稳定颈动脉斑块与白质病变数量之间的关联表明，血栓栓塞性斑块活动可能促进白质疏松症的发展，尤其是较小的单个病变。需要进行更大规模的研究来证实这一发现，并探索其对选择颈动脉内膜切除术候选者的潜在临床影响。
