Gröschel K, Pilgram S M, Ernemann U, Schnaudigel S, Nägele T, Knauth M, Kastrup A
Department of Neurology, University of Göttingen, Göttingen, Germany.
Eur J Neurol. 2008 Jul;15(7):730-6. doi: 10.1111/j.1468-1331.2008.02183.x. Epub 2008 May 27.
Aortic arch calcification (AC) on conventional angiograms has recently been shown to be associated with embolic complications during carotid artery stenting (CAS). Because conventional angiography is not routinely carried out in patients prior to CAS, a less invasive, commonly available diagnostic modality is warranted to identify AC.
We investigated the occurrence of AC on routinely acquired chest radiographs and its influence on diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke.
A total of 152 patients (mean age: 67.5 +/- 8.9 years, 112 men) underwent CAS and completed pre- and post-procedural DWI. AC larger than 1 cm in length was classified as relevant and could be detected in 63 patients (41.4%) on plain chest radiographs. In patients with AC, significantly more new DWI-lesions were found than in patients without AC [median 2; interquartile range (IQR): 0-7 vs. median 1, IQR: 0-2; P < 0.05]. After multivariate regression analysis, AC was independently associated with new post-procedural DWI lesions.
AC is a common finding in patients with a high-grade carotid stenosis and predicts embolic complications during CAS. Since AC can be detected on plain chest radiography, this diagnostic tool is useful to identify high-risk patients for CAS.
传统血管造影显示，主动脉弓钙化（AC）与颈动脉支架置入术（CAS）期间的栓塞并发症相关。由于CAS术前患者通常不常规进行传统血管造影，因此需要一种侵入性较小、常用的诊断方法来识别AC。
我们研究了常规获取的胸部X线片上AC的发生情况及其对作为卒中替代标志物的扩散加权成像（DWI）病变的影响。
共有152例患者（平均年龄：67.5±8.9岁，112例男性）接受了CAS，并完成了术前和术后DWI检查。长度大于1 cm的AC被归类为有意义的钙化，在63例患者（41.4%）的胸部平片上可检测到。与无AC的患者相比，有AC的患者发现的新DWI病变明显更多[中位数2；四分位间距（IQR）：0 - 7 vs.中位数1，IQR：0 - 2；P < 0.05]。多因素回归分析后，AC与术后新的DWI病变独立相关。
AC在重度颈动脉狭窄患者中很常见，并可预测CAS期间的栓塞并发症。由于AC可在胸部平片上检测到，因此该诊断工具有助于识别CAS的高危患者。
