Department of Cerebrovascular Diseases, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Kyushu University, Fukuoka, Japan.
Cerebrovasc Dis. 2010;30(6):606-11. doi: 10.1159/000319889. Epub 2010 Oct 15.
The present study investigated the frequency and morphological characteristics of carotid mobile plaques and examined the relationship between carotid mobile plaques and recurrent strokes.
The study included 94 consecutive acute stroke patients with large-artery atherosclerosis associated with extracranial carotid stenosis. We investigated the presence of mobile plaques by carotid ultrasonography and classified patients into two groups (mobile group and non-mobile group). We compared backgrounds, MRI and ultrasonographic findings, neurological severity on admission and at discharge, and the rate of early recurrent stroke between both groups.
Mobile plaques were detected in 12 patients (12.8%). There were four types of mobile plaques: (1) the jellyfish-type plaque, in which the fibrous cap fluctuated like a jellyfish; (2) the streaming-band-type plaque, in which the string attached to the plaque was swaying; (3) the mobile-thrombus-type plaque, in which a mobile mass was attached to the plaque surface, and (4) the fluctuating-ulcer-type plaque, which contained a mobile substance in the plaque ulcer. Although National Institutes of Health Stroke Scale (NIHSS) scores on admission were less severe in the mobile group than in the non-mobile group (median 1 vs. 4, respectively; p = 0.004), the rate of early recurrent stroke was significantly higher in the mobile group than in the non-mobile group (33.3 vs. 7.3%, respectively; p = 0.022). There were no significant differences in NIHSS scores at discharge between groups.
Morphologically, several types of mobile plaques were detected in consecutive patients with acute stroke associated with carotid stenosis. Mobile plaques are strongly associated with an early recurrence of stroke.
本研究调查了颈动脉易损斑块的频率和形态特征，并探讨了颈动脉易损斑块与复发性卒中之间的关系。
本研究纳入了 94 例伴有颅外颈动脉狭窄的大动脉粥样硬化性急性卒中患者。我们通过颈动脉超声检查来调查易损斑块的存在，并将患者分为两组（易损斑块组和非易损斑块组）。我们比较了两组患者的背景、MRI 和超声检查结果、入院时和出院时的神经功能严重程度以及早期复发性卒中的发生率。
在 12 例患者（12.8%）中检测到易损斑块。易损斑块有 4 种类型：（1）水母型斑块，纤维帽像水母一样波动；（2）流动带型斑块，附着在斑块上的绳子在摆动；（3）易损血栓型斑块，斑块表面附着有易损血栓；（4）波动溃疡型斑块，斑块溃疡内含有易损物质。尽管易损斑块组患者入院时的国立卫生研究院卒中量表（NIHSS）评分较非易损斑块组低（中位数分别为 1 分和 4 分；p = 0.004），但易损斑块组患者早期复发性卒中的发生率明显高于非易损斑块组（分别为 33.3%和 7.3%；p = 0.022）。两组患者出院时的 NIHSS 评分无显著差异。
在连续伴有颈动脉狭窄的急性卒中患者中，检测到几种类型的易损斑块。易损斑块与卒中早期复发密切相关。
