Gao Tianli, Zhang Zhuo, Yu Wei, Zhang Zhaoqi, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Cerebrovasc Dis. 2009;27(4):345-52. doi: 10.1159/000202011. Epub 2009 Feb 14.
High-resolution contrast-enhanced magnetic resonance imaging (CEMRI) has been proven to be an effective tool for the identification of carotid atherosclerotic vulnerable plaque, such as a large lipid core and thin fibrous cap. The aim of this study was to evaluate the relationship between carotid plaque characteristics and the types of stroke in patients who had carotid artery (CA) stenosis > or =50%.
102 consecutive subjects (mean age 67.2 +/- 10.2 years; 73 males) who initially had ischemic stroke or asymptomatic CA stenosis from 50 to 100% diagnosed by ultrasound were included in this study. Carotid CEMRI, brain MRI and magnetic resonance angiography were performed to understand the infarct patterns and to exclude intracranial artery stenosis. The modified American Heart Association (AHA) plaque classification was used in our study.
Our study demonstrated that 45 patients had CA stroke, and 55 patients had lacunar and asymptomatic lesions. The majority of patients had AHA classification type IV-V and VI which presented as vulnerable plaques. Of 63 patients with mild to moderate stenosis (< or =70%), 44 (69.8%) had type IV-V vulnerable plaques, which was significantly higher than those of patients with severe stenosis (>70%; p < 0.001). In CA stroke, the number of patients with a thin or ruptured fibrous cap was twice that of those with a thick and intact fibrous cap.
CEMRI may have important applications in clinical risk evaluations in CA atherosclerosis. Physicians ought to recognize that different types of stroke should be identified by brain MRI detection before invasive therapies.
高分辨率对比增强磁共振成像（CEMRI）已被证明是识别颈动脉粥样硬化易损斑块的有效工具，如大脂质核心和薄纤维帽。本研究的目的是评估颈动脉狭窄≥50%的患者中颈动脉斑块特征与卒中类型之间的关系。
本研究纳入了102例连续的受试者（平均年龄67.2±10.2岁；73例男性），这些受试者最初经超声诊断为缺血性卒中或无症状性颈动脉狭窄50%至100%。进行颈动脉CEMRI、脑部MRI和磁共振血管造影以了解梗死模式并排除颅内动脉狭窄。本研究采用改良的美国心脏协会（AHA）斑块分类。
我们的研究表明，45例患者发生颈动脉卒中，55例患者有腔隙性和无症状性病变。大多数患者的AHA分类为IV-V型和VI型，表现为易损斑块。在63例轻度至中度狭窄（≤70%）的患者中，44例（69.8%）有IV-V型易损斑块，这显著高于重度狭窄（>70%）患者（p<0.001）。在颈动脉卒中患者中，纤维帽薄或破裂患者的数量是纤维帽厚且完整患者的两倍。
CEMRI在颈动脉粥样硬化的临床风险评估中可能具有重要应用。医生应认识到，在进行侵入性治疗之前，应通过脑部MRI检测识别不同类型的卒中。
