Milosević Djordje, Pasternak Janko, Popović Vladan, Nikolić Dragan, Milosević Pavle, Manojlović Vladimir
Clinic for Vascular and Transplant Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia.
Clinic for Abdominal, Endocrine and Transplant Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia.
Vojnosanit Pregl. 2013 Nov;70(11):993-8. doi: 10.2298/vsp110519020m.
BACKGROUND/AIM: A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke by modern imaging methods. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque.
This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 tears. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm.
Out of 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05).
Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.
背景/目的：一定比例无症状性颈动脉狭窄患者存在不稳定颈动脉斑块。对于这些患者，有可能记录脑实质病变的存在——无症状脑梗死。通过现代成像方法，这些患者发生缺血性卒中的风险更高。本研究的目的是分析无症状性颈动脉狭窄患者动脉粥样硬化性颈动脉斑块形态与无症状脑梗死表现之间的联系，并分析心血管疾病危险因素对无症状脑梗死发生及颈动脉斑块形态的影响。
这项回顾性研究纳入了在伏伊伏丁那临床中心血管与移植外科诊所接受手术治疗的颅外动脉粥样硬化性颈动脉高度狭窄（>70%）患者，研究时间跨度为5年。所分析的患者在手术时无颈动脉区域脑血管功能不全的临床表现。根据Gray-Weale分类法对颈动脉斑块形态进行分类，之后将所有类型再细分为两组：稳定型和不稳定型。通过术前脑实质磁共振成像来确认脑部病变。我们分析了同侧大小≥3 mm的病变。
201例患者中，78%有稳定斑块，22%有不稳定斑块。不稳定斑块在男性患者中更为常见（男/女比例 = 24.8% : 17.8%），但无统计学显著差异（p>0.05）。危险因素（高血压、吸烟、高脂蛋白血症和糖尿病）对颈动脉斑块形态及无症状脑梗死的发生无统计学显著影响。30.8%的患者检测到无症状脑梗死。无症状脑梗死患者中发现不稳定颈动脉斑块的比例更高（36.4% : 29.3%），但无显著统计学差异（p>0.05）。
尽管无症状脑梗死在颈动脉分叉处不稳定斑块患者中更常见，但差异无统计学意义。危险因素的数量和类型对无症状性颈动脉斑块形态的发生率无统计学意义。
