Department of Neurosurgery, Kyoto University School of Medicine, Kyoto, Japan.
Neurosurgery. 2012 May;70(5):1143-50; discussion 1150-1. doi: 10.1227/NEU.0b013e31823fe50b.
Carotid plaque characteristics influence future risk of stroke considerably. However, the severity of stenosis does not accurately reflect plaque burden in patients with expansive arterial remodeling.
To determine the therapeutic outcome of symptomatic carotid low-grade stenosis with vulnerable plaque based on magnetic resonance imaging (MRI) characterization.
We studied 25 (male, n = 23; age, 74.2 ± 5.6 years) of 29 consecutive patients with symptomatic carotid low-grade stenosis (<50%) and both high-signal plaque and expansive remodeling on T1-weighted MRIs. The remaining 4 were excluded because of impending stroke. A single antithrombotic and statin were administered, and recurrent ischemic stroke was treated with dual antithrombotics. We considered carotid endarterectomy when recurrence was refractory to aggressive medical treatment.
During a 31.3 ± 16.4-month follow-up, 11 of the 25 patients developed a total of 30 recurrent ischemic events (46.0% per patient-year). The patients' characteristics did not differ significantly between the groups with and without recurrence (n = 11 and n = 14, respectively). Seven of 11 patients in the recurrence group treated with carotid endarterectomy remained free of ischemic events during a postoperative follow-up of 19.1 ± 14.6 months.
Symptomatic low-grade carotid stenosis with vulnerable plaque confirmed by MRI was associated with a high rate of stroke recurrence that was refractory to aggressive medical treatment. However, carotid endarterectomy was safe and effective for such patients. Plaque characterization by MRI has the potential for more accurate stroke risk stratification in the management of carotid low-grade stenosis.
颈动脉斑块特征对未来中风风险有重要影响。然而，狭窄的严重程度并不能准确反映具有扩张性动脉重塑的患者的斑块负担。
根据磁共振成像（MRI）特征确定有症状的颈动脉低级别狭窄伴易损斑块的治疗效果。
我们研究了 29 例连续患者中的 25 例（男，n = 23；年龄 74.2 ± 5.6 岁），这些患者均有症状性颈动脉低级别狭窄（<50%），且 T1 加权 MRI 上有高信号斑块和扩张性重塑。其余 4 例因即将发生中风而被排除在外。给予单一抗血栓和他汀类药物治疗，复发缺血性中风采用双联抗血栓治疗。当复发对强化药物治疗无反应时，考虑颈动脉内膜切除术。
在 31.3 ± 16.4 个月的随访期间，25 例患者中有 11 例（46.0%/患者年）共发生 30 次复发性缺血事件。复发组和无复发组患者的特征无显著差异（分别为 n = 11 和 n = 14）。在 19.1 ± 14.6 个月的术后随访中，复发组中接受颈动脉内膜切除术的 7 例患者均无缺血事件发生。
MRI 证实的有症状性低级别颈动脉狭窄伴易损斑块与强化药物治疗后复发的高卒中率相关。然而，颈动脉内膜切除术对这类患者是安全有效的。MRI 斑块特征分析在颈动脉低级别狭窄的管理中具有更准确的卒中风险分层潜力。
