Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, Kentucky.
Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Interventional Cardiology, Pitangueiras Hospital, Jundiai, SP, Brazil.
JACC Cardiovasc Interv. 2014 Jun;7(6):674-84. doi: 10.1016/j.jcin.2014.01.163.
The goal of this study was to investigate carotid plaque characteristics in symptomatic versus asymptomatic patients with the use of nonocclusive optical coherence tomography (OCT).
The identification of asymptomatic patients with carotid disease who are at risk of stroke remains a challenge. There is an increasing awareness that plaque characteristics may best risk-stratify this population. We hypothesized that OCT, a new high-resolution (∼ 10 μm) imaging modality, might be useful for the identification of low-risk versus high-risk carotid plaque features and help us to understand the relationship between carotid diameter stenosis and plaque morphology to ischemic stroke.
Fifty-three patients undergoing diagnostic carotid angiography were studied with OCT. Data analysis was carried out by imaging experts who were unaware of the clinical characteristics of the study population.
Plaque with American Heart Association type VI complicated features was more common in symptomatic than asymptomatic patients (74.1% vs. 36.4%, p = 0.02). This was largely driven by differences in the incidence of thin-cap fibroatheroma with rupture (40.7% vs. 13.6%, p = 0.056) and thrombus (67.7% vs. 36.4%, p = 0.034). Conversely, non-type VI plaques were more common in asymptomatic than symptomatic patients (63.6% vs. 25.9%, p = 0.02). No association between the degree of stenosis and plaque morphology was identified.
This retrospective analysis of carotid OCT data supports the hypothesis that the evaluation of carotid plaque characteristics with this high-resolution imaging technique has the potential to alter the understanding and treatment of carotid artery disease.
本研究旨在利用非闭塞光学相干断层扫描（OCT）技术研究有症状与无症状患者颈动脉斑块的特征。
识别具有颈动脉疾病且有中风风险的无症状患者仍然是一个挑战。人们越来越意识到，斑块特征可能是对这类人群进行最佳风险分层的关键。我们假设，OCT 是一种新的高分辨率（约 10μm）成像方式，可能有助于识别低风险与高风险颈动脉斑块特征，并帮助我们了解颈动脉直径狭窄与斑块形态学与缺血性中风之间的关系。
对 53 例行诊断性颈动脉血管造影术的患者进行了 OCT 检查。数据分析由对研究人群的临床特征不知情的成像专家进行。
与无症状患者相比，有症状患者颈动脉斑块具有美国心脏协会 VI 型复杂特征更为常见（74.1% vs. 36.4%，p = 0.02）。这主要是由于易损性薄帽纤维粥样斑块伴破裂（40.7% vs. 13.6%，p = 0.056）和血栓（67.7% vs. 36.4%，p = 0.034）发生率的差异所致。相反，无症状患者中非 VI 型斑块更为常见（63.6% vs. 25.9%，p = 0.02）。未发现狭窄程度与斑块形态之间存在关联。
本研究对颈动脉 OCT 数据的回顾性分析支持了这样一种假设，即利用这种高分辨率成像技术评估颈动脉斑块特征有可能改变对颈动脉疾病的认识和治疗。
