Katano Hiroyuki, Yamada Kazuo, Sakurai Keita, Takahashi Satoru
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical Informatics & Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2920-2927. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.043. Epub 2014 Oct 16.
BACKGROUND: The aim of the study was to investigate the depiction of the carotid artery by fluorescein sodium (FS) videoangiography compared with indocyanine green (ICG) videoangiography, focusing on how the vasa vasorum of the carotid artery is depicted. METHODS: Thirty-five patients (19 FS patients, 16 ICG patients, mean age 69.4 ± 5.1 years, mean degree of stenosis 78.7% ± 11.7%) who underwent a carotid endarterectomy (CEA) were enrolled. FS (5-6 mg/kg) or ICG (.2-.3 mg/kg) was injected intravenously as a bolus before the arterectomy during the CEA. The intravascular fluorescence signal was recorded with a digital video camera integrated on a microscope. Magnetic resonance imaging black-blood (BB) T1-weighted imaging (WI) was preoperatively performed using a 1.5-T whole-body imager, and the signal intensity ratio relative to the ipsilateral sternocleidomastoid muscle on BB-T1WI (BB-SIR) was calculated. We also performed an immunohistochemistry study using CD31 and CD68 antibodies for plaque specimens. RESULTS: In the FS videoangiography series, the vasa vasorum of carotid adventitia was depicted first, followed by augmentation of FS of the wall and partially the inner lumen (pattern A) in 6 cases. Augmentation of FS of the wall and inner lumen prior or simultaneous to the depiction of the vasa vasorum of the carotid adventitia (pattern B) were observed in 13 cases. The average BB-SIR value of the pattern B cases was significantly higher than that in the pattern A group (P < .05). Most of the plaques with BB-SIR values higher than 1.25 also belonged to the pattern B group (90.9%). Microvessels stained by CD31 and macrophages stained by CD68 were more frequently observed in the high-BB-SIR plaques. In contrast, the ICG videoangiography uniformly showed pattern B in all 16 cases, because of the fluorolucency of the carotid wall revealed by the ICG. CONCLUSIONS: The early depiction of adventitial vasa vasorum in FS videoangiography was inversely associated with the BB-SIR values of the plaques, along with many microvessels and macrophages that have been reported to have a tendency of intraplaque hemorrhage or symptoms. The present results may support the idea of an intimal origin of the neovascularization in vulnerable carotid plaques, and they demonstrated the potential of intraoperative plaque imaging by FS videoangiography.
背景：本研究旨在对比荧光素钠（FS）血管造影与吲哚菁绿（ICG）血管造影对颈动脉的显示情况，重点关注颈动脉滋养血管的显示方式。 方法：纳入35例行颈动脉内膜切除术（CEA）的患者（19例使用FS，16例使用ICG，平均年龄69.4±5.1岁，平均狭窄程度78.7%±11.7%）。在CEA手术过程中，于动脉切除术前行静脉推注注射FS（5 - 6mg/kg）或ICG（0.2 - 0.3mg/kg）。使用集成在显微镜上的数字摄像机记录血管内荧光信号。术前使用1.5T全身成像仪进行磁共振成像黑血（BB）T1加权成像（WI），并计算BB-T1WI上相对于同侧胸锁乳突肌的信号强度比（BB-SIR）。我们还对斑块标本使用CD31和CD68抗体进行了免疫组织化学研究。 结果：在FS血管造影系列中，6例患者首先显示颈动脉外膜的滋养血管，随后血管壁和部分内膜腔的FS增强（模式A）。13例患者观察到在颈动脉外膜滋养血管显示之前或同时血管壁和内膜腔的FS增强（模式B）。模式B组的平均BB-SIR值显著高于模式A组（P < 0.05）。大多数BB-SIR值高于1.25的斑块也属于模式B组（90.9%）。在高BB-SIR斑块中更频繁地观察到CD31染色的微血管和CD68染色的巨噬细胞。相比之下，由于ICG显示出颈动脉壁的荧光性，ICG血管造影在所有16例患者中均一致显示模式B。 结论：FS血管造影中外膜滋养血管的早期显示与斑块的BB-SIR值呈负相关，同时存在许多据报道有斑块内出血倾向或症状的微血管和巨噬细胞。目前的结果可能支持易损颈动脉斑块新生血管形成起源于内膜的观点，并且它们证明了FS血管造影在术中斑块成像方面的潜力。
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