Department of Radiology and Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain.
J Endovasc Ther. 2012 Dec;19(6):764-73. doi: 10.1583/JEVT-12-3914MR2.1.
To determine the incidence of vulnerable plaques characterized by virtual histology intravascular ultrasound (VH IVUS) in patients with severe internal carotid artery (ICA) stenosis and its relationship to the timing of protected carotid artery stenting (CAS).
The study included 141 patients (119 men; mean age 66.9 ± 9 years) with severe ICA stenosis undergoing CAS with cerebral protection. Patients were classified in 3 groups: 39 symptomatic early CAS (<14 days from clinical symptoms); 58 symptomatic delayed CAS (range 15-180 days), and 44 asymptomatic CAS. Culprit plaque component was evaluated by VH IVUS. A vulnerable plaque was defined by a thin-cap fibroatheroma and/or calcified thin-cap fibroatheroma.
The composite disabling stroke/mortality was 2.1%. The incidence of vulnerable plaques was significantly higher in the symptomatic early CAS group (25/39, 64.1%) than in the symptomatic delayed CAS group (26/58, 44.8%; p=0.048) or the asymptomatic CAS group (14/44, 31.8%; p=0.003). Symptomatic patients showed a significantly higher incidence of vulnerable plaques (52.6%) than asymptomatic patients (31.8%, p=0.022). There were no significant differences between the symptomatic delayed and asymptomatic groups (p=0.129). By clinical subgroup, a vulnerable plaque was observed in 29 (52.7%) of the patients with 55 transient ischemic attacks, 22 (52.4%) of the 42 minor stroke patients, and 14 (31.8%) of the 44 asymptomatic patients (p=0.152).
The incidence of vulnerable plaques was significantly higher in symptomatic patients, increasing as the intravascular study was performed closer to the index ischemic episode.
确定虚拟组织学血管内超声（VH-IVUS）检测到的易损斑块在严重颈内动脉（ICA）狭窄患者中的发生率及其与颈动脉保护支架置入术（CAS）时间的关系。
本研究纳入了 141 名接受 CAS 联合脑保护的严重 ICA 狭窄患者（119 名男性；平均年龄 66.9±9 岁）。患者被分为 3 组：39 名症状性早期 CAS（症状发生后<14 天）；58 名症状性延迟 CAS（15-180 天）；44 名无症状性 CAS。采用 VH-IVUS 评估罪犯斑块成分。易损斑块定义为薄帽纤维粥样斑块和/或钙化薄帽纤维粥样斑块。
复合致残性卒中/死亡率为 2.1%。症状性早期 CAS 组（25/39，64.1%）易损斑块的发生率明显高于症状性延迟 CAS 组（26/58，44.8%；p=0.048）或无症状性 CAS 组（14/44，31.8%；p=0.003）。有症状的患者易损斑块发生率（52.6%）明显高于无症状患者（31.8%，p=0.022）。症状性延迟和无症状组之间无显著差异（p=0.129）。按临床亚组分析，55 例短暂性脑缺血发作患者中有 29 例（52.7%）、42 例轻度卒中患者中有 22 例（52.4%）和 44 例无症状患者中有 14 例（31.8%）存在易损斑块（p=0.152）。
在症状性患者中易损斑块的发生率明显更高，且随着血管内研究与索引缺血事件的时间间隔缩短而增加。
