Department of Cardiovascular Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
J Vasc Surg. 2010 Feb;51(2):345-50. doi: 10.1016/j.jvs.2009.08.080.
Although the association between vulnerable lesions and cardiovascular events is well established, little is known about their relationship to postsurgery restenosis. To address this issue, we initiated a prospective, nonrandomized study to examine the femoral plaques on both sides in patients who were undergoing eversion carotid endarterectomy (CEA) and were longitudinally followed-up for early restenosis development.
The final analysis enrolled 321 patients (189 women) with a median age of 67.0 years (interquartile range, 59.0-73.0 years), who underwent eversion CEA (2005 to 2007). Using duplex ultrasound scanning, we evaluated 321 common femoral atherosclerotic lesions on the day before CEA. A quantitative scale was used to grade the size of plaques as grade 1, one or more small plaques (<20 mm2); grade 2, moderate to large plaques; and grade 3, plaques giving flow disturbances. The plaque morphology in terms of echogenicity was graded as echolucent, 1; predominantly echolucent, 2; predominantly echogenic, 3; echogenic 4; or calcified, 5. The plaque surface was categorized as smooth, irregular, or ulcerated. The patients underwent carotid duplex ultrasound imaging at 6 weeks and at 6, 12, and 24 months after CEA. Mann-Whitney U test, chi2 test, and multivariate logistic regression were used for statistical evaluation.
Internal carotid artery restenosis of > or = 50% was detected in 33 patients (10.28%) in the operated region. Neither the size (grade 1, P = .793; grade 2, P = .540; grade 3, P = .395) nor the surface characteristics of the femoral plaques (smooth, P = .278; irregular, P = .281; ulcerated, P = .934) were significantly different between the patients with and without carotid restenosis. Echolucent-predominantly echolucent femoral lesions were an independent predictor of recurrent carotid stenosis (adjusted odds ratio, 5.63; 95% confidence interval, 2.14-10.89; P < .001).
Ultrasound evaluation of femoral plaque morphology before CEA can be useful for identifying patients at higher risk for carotid restenosis.
虽然易损斑块与心血管事件之间的关联已得到充分证实，但对于它们与术后再狭窄的关系知之甚少。为了解决这个问题，我们进行了一项前瞻性、非随机研究，以检查接受外翻颈动脉内膜切除术（CEA）的患者双侧股动脉斑块，并对其进行了纵向随访以观察早期再狭窄的发生情况。
最终分析纳入了 321 名患者（189 名女性），中位年龄为 67.0 岁（四分位距，59.0-73.0 岁），这些患者于 2005 年至 2007 年接受了外翻 CEA。使用双功能超声扫描，我们在 CEA 前一天评估了 321 例股总动脉粥样硬化病变。使用定量评分标准将斑块大小分为 1 级，即一个或多个小斑块（<20mm²）；2 级，为中至大斑块；3 级，为引起血流紊乱的斑块。根据回声特性将斑块形态分为低回声 1 级；以低回声为主 2 级；以强回声为主 3 级；强回声 4 级；或钙化 5 级。斑块表面分为光滑、不规则或溃疡。患者在 CEA 后 6 周、6、12 和 24 个月进行颈动脉双功能超声检查。采用 Mann-Whitney U 检验、卡方检验和多变量逻辑回归进行统计学评估。
在手术区域内，有 33 名患者（10.28%）检测到颈内动脉再狭窄>50%。股动脉斑块的大小（1 级，P=0.793；2 级，P=0.540；3 级，P=0.395）和表面特征（光滑，P=0.278；不规则，P=0.281；溃疡，P=0.934）在有和无颈动脉再狭窄的患者之间均无显著差异。超声检查显示股动脉斑块以低回声为主（低回声为主或以低回声为主）是颈动脉再狭窄的独立预测因素（校正优势比，5.63；95%置信区间，2.14-10.89；P<0.001）。
CEA 前股动脉斑块形态的超声评估有助于识别颈动脉再狭窄风险较高的患者。
