Truijman M T B, Kooi M E, van Dijk A C, de Rotte A A J, van der Kolk A G, Liem M I, Schreuder F H B M, Boersma E, Mess W H, van Oostenbrugge R J, Koudstaal P J, Kappelle L J, Nederkoorn P J, Nederveen A J, Hendrikse J, van der Steen A F W, Daemen M J A P, van der Lugt A
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
Int J Stroke. 2014 Aug;9(6):747-54. doi: 10.1111/ijs.12167. Epub 2013 Oct 21.
Patients with symptomatic carotid artery stenosis are at high risk for recurrent stroke. To date, the decision to perform carotid endarterectomy in patients with a recent cerebrovascular event is mainly based on degree of stenosis of the ipsilateral carotid artery. However, additional atherosclerotic plaque characteristics might be better predictors of stroke, allowing for more precise selection of patients for carotid endarterectomy.
We investigate the hypothesis that the assessment of carotid plaque characteristics with magnetic resonance imaging, multidetector-row computed tomography angiography, ultrasonography, and transcranial Doppler, either alone or in combination, may improve identification of a subgroup of patients with < 70% carotid artery stenosis with an increased risk of recurrent stroke.
The Plaque At RISK (PARISK) study is a prospective multicenter cohort study of patients with recent (<3 months) neurological symptoms due to ischemia in the territory of the carotid artery and < 70% ipsilateral carotid artery stenosis who are not scheduled for carotid endarterectomy or stenting. At baseline, 300 patients will undergo magnetic resonance imaging, multidetector-row computed tomography angiography, and ultrasonography examination of the carotid arteries. In addition, magnetic resonance imaging of the brain, ambulatory transcranial Doppler recording of the middle cerebral artery and blood withdrawal will be performed. After two-years, imaging will be repeated in 150 patients. All patients undergo a follow-up brain magnetic resonance imaging, and there will be regular clinical follow-up until the end of the study.
The combined primary end-point contains ipsilateral recurrent ischemic stroke or transient ischemic attack or new ipsilateral ischemic brain lesions on follow-up brain magnetic resonance imaging.
有症状的颈动脉狭窄患者发生复发性中风的风险很高。迄今为止，对于近期发生脑血管事件的患者，决定是否进行颈动脉内膜切除术主要基于同侧颈动脉的狭窄程度。然而，其他动脉粥样硬化斑块特征可能是更好的中风预测指标，从而能够更精确地选择适合进行颈动脉内膜切除术的患者。
我们研究这样一个假设，即单独或联合使用磁共振成像、多排螺旋计算机断层血管造影、超声检查和经颅多普勒来评估颈动脉斑块特征，可能会改善对同侧颈动脉狭窄程度<70%且复发性中风风险增加的患者亚组的识别。
“斑块风险（PARISK）研究”是一项前瞻性多中心队列研究，研究对象为近期（<3个月）因颈动脉供血区域缺血出现神经症状且同侧颈动脉狭窄程度<70%、未计划进行颈动脉内膜切除术或支架置入术的患者。在基线时，300名患者将接受颈动脉的磁共振成像、多排螺旋计算机断层血管造影和超声检查。此外，还将进行脑部磁共振成像、大脑中动脉动态经颅多普勒记录以及采血。两年后，150名患者将重复进行成像检查。所有患者均接受随访脑部磁共振成像检查，并将进行定期临床随访直至研究结束。
联合主要终点包括随访脑部磁共振成像时出现的同侧复发性缺血性中风或短暂性脑缺血发作或新的同侧缺血性脑病变。
