Tanabe Jun, Tanaka Michihiro, Kadooka Keisuke, Hadeishi Hiromu
Department of Neurosurgery, Kameda Medical Center, Kamogawa City, Chiba Prefecture, Japan Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita City, Akita Prefecture, Japan.
Department of Neurosurgery, Kameda Medical Center, Kamogawa City, Chiba Prefecture, Japan.
J Neurointerv Surg. 2016 Mar;8(3):305-8. doi: 10.1136/neurintsurg-2014-011584. Epub 2015 Jan 22.
A major disadvantage of carotid artery stenting (CAS) is the high incidence of perioperative cerebral embolism. Cerebral embolism after CAS is associated with soft plaque. Currently, higher spatial resolution imaging can be obtained with cone-beam CT (CB-CT). The correlation between the degree of contrast enhancement of the vasa vasorum (VV) on CB-CT and the vulnerability of plaque in terms of risk factors for CAS was evaluated.
18 patients who underwent CAS had high-resolution CB-CT to evaluate enhancement of the VV covering carotid plaque performed intraoperatively. The appearance of the surface of the carotid plaque was classified as either enhancing (VV-positive) or non-enhancing (VV-negative). Carotid plaque vulnerability on black-blood MRI (BB-MRI) and postoperative ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) were analyzed in the two groups.
Of the 18 patients, 9 were VV-positive and 9 were VV-negative. The proportion of ipsilateral new ischemic lesions on DWI was significantly higher in the VV-positive group than in the VV-negative group (8/9 patients (88.9%) vs 3/9 patients (33.3%), p=0.026). BB-MRI was performed preoperatively in 15 of 18 patients. The proportion of unstable plaque on BB-MRI was significantly higher in the VV-positive group than in the VV-negative group (9/9 patients (100%) vs 1/6 patients (16.7%), p=0.002).
Enhancement of the VV covering carotid plaque on high-resolution CB-CT was significantly associated with unstable plaque on BB-MRI and postoperative ipsilateral new ischemic lesions.
颈动脉支架置入术（CAS）的一个主要缺点是围手术期脑栓塞的发生率较高。CAS术后的脑栓塞与软斑块有关。目前，锥形束CT（CB-CT）可获得更高空间分辨率的图像。评估了CB-CT上血管滋养管（VV）的对比增强程度与CAS危险因素方面斑块易损性之间的相关性。
18例行CAS的患者术中接受了高分辨率CB-CT检查，以评估覆盖颈动脉斑块的VV的增强情况。将颈动脉斑块表面的表现分为增强（VV阳性）或不增强（VV阴性）。分析两组患者在黑血磁共振成像（BB-MRI）上的颈动脉斑块易损性以及术后弥散加权成像（DWI）上同侧缺血性病变情况。
18例患者中，9例为VV阳性，9例为VV阴性。VV阳性组DWI上同侧新发缺血性病变的比例显著高于VV阴性组（8/9例患者（88.9%）对3/9例患者（33.3%），p=0.026）。18例患者中有15例术前进行了BB-MRI检查。VV阳性组BB-MRI上不稳定斑块的比例显著高于VV阴性组（9/9例患者（100%）对1/6例患者（16.7%），p=0.002）。
高分辨率CB-CT上覆盖颈动脉斑块的VV增强与BB-MRI上的不稳定斑块及术后同侧新发缺血性病变显著相关。
