Centre for Applied Biomedical Engineering Research (CABER), Health Research Institute (HRI), School of Engineering, Bernal Institute, University of Limerick, Limerick, Ireland.
Department of Radiology, University Hospital Limerick, Limerick, Ireland.
Eur J Vasc Endovasc Surg. 2017 Oct;54(4):431-438. doi: 10.1016/j.ejvs.2017.07.022. Epub 2017 Aug 21.
OBJECTIVE/BACKGROUND: Carotid artery stenting (CAS) in calcified arteries carries a higher peri-operative risk. This study investigates the relationship between the stretching limits of carotid plaque samples and calcification in order to determine a stretch tolerance criterion for endovascular intervention.
Seventeen carotid plaque samples were acquired from standard endarterectomy procedures. The maximum stretch capability of the global plaque was determined by circumferentially extending the tissue to complete failure. Quantitative assessment of calcification was performed using high resolution computed tomography, including measures of percent calcification volume fraction (%CVF) and calcification configuration. Maximum stretch properties were then related to calcification measures in order to evaluate the predictive power of calcification for determining plaque stretching limits.
A strong negative correlation was found between %CVF and stretch ratio with respect to specific calcification configuration types. All plaques with < 70% stenosis superseded the minimum required stretch threshold. Severe stenosis (> 70%) warrants a stretch of at least 2.33 during revascularisation and only plaques containing concentric calcifications with < 20% CVF successfully reached this minimum required stretch threshold.
The addition of calcification measures to the stenosis classification may help in guiding endovascular intervention techniques to achieve a balance between an acceptable residual patency level while avoiding plaque rupture in calcified carotid plaques.
目的/背景：在钙化的动脉中进行颈动脉支架置入术（CAS）会增加围手术期风险。本研究旨在探讨颈动脉斑块样本拉伸极限与钙化之间的关系，以确定血管内介入治疗的拉伸耐受标准。
从标准颈动脉内膜切除术获得了 17 个颈动脉斑块样本。通过环形扩展组织直至完全失效来确定整个斑块的最大拉伸能力。使用高分辨率计算机断层扫描对钙化进行定量评估，包括钙化体积分数（%CVF）和钙化形态的测量。然后将最大拉伸特性与钙化测量值相关联，以评估钙化对确定斑块拉伸极限的预测能力。
%CVF 与特定钙化形态类型的拉伸比之间存在强烈的负相关。所有狭窄<70%的斑块都超过了最小要求的拉伸阈值。严重狭窄（>70%）需要至少 2.33 的拉伸比进行再血管化，只有含有<20%CVF 的同心钙化的斑块才能成功达到这一最小要求的拉伸阈值。
将钙化测量值添加到狭窄分类中，可能有助于指导血管内介入技术，在可接受的残余通畅水平和避免钙化颈动脉斑块破裂之间取得平衡。
