女性中脂质含量低的斑块和无症状状态与颈动脉内膜切除术后双功超声检查时较高的收缩期峰值速度相关。

Vrijenhoek Joyce E P, de Borst Gert Jan, den Ruijter Hester M, Merckelbach Sophie M E, de Kleijn Dominique P V, Pasterkamp Gerard, Moll Frans L

Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Atherosclerosis. 2014 Dec;237(2):677-83. doi: 10.1016/j.atherosclerosis.2014.10.093. Epub 2014 Oct 28.

OBJECTIVES

Recurrent stenosis is a drawback of carotid endarterectomy (CEA), and may lead to recurrent symptoms and reintervention. Restenosis can be detected by duplex ultrasound scanning (DUS) with cutoff values based on peak systolic velocity (PSV), which vary among vascular laboratories. On short term, histological carotid plaque characteristics have shown to predict DUS-based restenosis rates. Therefore, we aimed to analyze the association of both plaque and patient characteristics with continuous PSV values in the carotid artery at different timepoints during follow-up after CEA.

METHODS

760 atherosclerotic plaques of 725 patients, who underwent CEA between 2003 and 2011, were analyzed for smooth muscle cells, collagen, macrophages, lipid core, plaque hemorrhage, and vessel density. Patients underwent DUS at 3 and 12 months follow-up and yearly thereafter. The association between plaque and patient characteristics and mean PSV was analyzed in a multivariable analysis, at 3 months and total (mid-term) follow-up.

RESULTS

Patients with a large lipid core in their plaque (n = 170) had significantly lower PSVs at 3 months follow-up; 109 cm/s, 95% confidence interval (CI): 103-116 versus 118 cm/s, 95% CI: 114-122, (P = 0.03) for no or small lipid core (n = 454). After mid-term follow-up (median duration of 2.5 years, interquartile range 1.7-4.3), these PSV values were not significantly different (115 vs. 111 cm/s, P = 0.278). Presence of contralateral stenosis, female sex, and asymptomatic presentation in women were independently associated with higher PSVs at mid-term follow-up.

CONCLUSIONS

Dissection of a lipid-poor plaque showed an independent association with higher PSVs in the internal carotid artery 3 months after CEA, not after mid-term follow-up. In women, significantly higher PSVs were found after midterm follow-up, especially if they were asymptomatic.

目的

复发性狭窄是颈动脉内膜切除术（CEA）的一个缺点，可能导致症状复发和再次干预。可以通过基于收缩期峰值流速（PSV）临界值的双功超声扫描（DUS）检测再狭窄，而这些临界值在不同血管实验室有所不同。短期内，组织学颈动脉斑块特征已显示可预测基于DUS的再狭窄率。因此，我们旨在分析CEA术后随访期间不同时间点颈动脉斑块和患者特征与连续PSV值之间的关联。

方法

对2003年至2011年间接受CEA的725例患者的760个动脉粥样硬化斑块进行分析，观察平滑肌细胞、胶原蛋白、巨噬细胞、脂质核心、斑块内出血和血管密度情况。患者在术后3个月和12个月进行DUS检查，之后每年检查一次。在多变量分析中，分析了斑块和患者特征与平均PSV在3个月及整个（中期）随访期间的关联。

结果

斑块中有大脂质核心的患者（n = 170）在术后3个月时PSV显著较低；脂质核心无或小的患者（n = 454）为118 cm/s，95%置信区间（CI）：114 - 122，而有大脂质核心的患者为109 cm/s，95% CI：103 - 116，（P = 0.03）。中期随访（中位持续时间2.5年，四分位间距1.7 - 4.3）后，这些PSV值无显著差异（115 vs. 111 cm/s，P = 0.278）。对侧狭窄、女性以及女性无症状表现与中期随访时较高的PSV独立相关。