Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China.
Department of Radiology, University of Washington, Seattle, WA.
J Am Heart Assoc. 2017 Aug 14;6(8):e005831. doi: 10.1161/JAHA.117.005831.
Carotid atherosclerotic plaque rupture is an important source of ischemic stroke. However, the prevalence of high-risk plaque (HRP) defined as plaques with luminal surface disruption, a lipid-rich necrotic core occupying >40% of the wall, or intraplaque hemorrhage in Chinese population remains unclear. This study uses carotid magnetic resonance imaging (CMRI) to investigate HRP prevalence in carotid arteries of Chinese patients with cerebrovascular symptoms.
Patients with cerebral ischemic symptoms in the anterior circulation within 2 weeks and carotid plaque determined by ultrasound were recruited and underwent CMRI. The HRP features were identified and compared between symptomatic and asymptomatic arteries. Receiver-operating-characteristic analysis was used to calculate area-under-the-curve (AUC) of stenosis and maximum wall thickness for discriminating presence of HRP. In 1047 recruited subjects, HRP detected by CMRI was nearly 1.5 times more prevalent than severe stenosis (≥50%) in this cohort (28% versus 19%, <0.0001). Approximately two thirds of HRPs were found in arteries with <50% stenosis. The prevalence of HRP in symptomatic carotid arteries was significantly higher than that of the contralateral asymptomatic carotid arteries (23.0% versus 16.4%, =0.001). Maximum wall thickness was found to be a stronger discriminator than stenosis for HRP (AUC: 0.93 versus 0.81, <0.0001).
There are significantly more high-risk carotid plaques than carotid arteries with ≥50% stenosis in symptomatic Chinese patients. A substantial number of HRPs were found in arteries with lower grade stenosis and maximum wall thickness was a stronger indicator for HRP than luminal stenosis.
URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02017756.
颈动脉粥样硬化斑块破裂是缺血性卒中的重要来源。然而，在中国人群中，管腔表面破裂、富含脂质的坏死核心占壁面积>40%或斑块内出血的高危斑块（HRP）的患病率尚不清楚。本研究使用颈动脉磁共振成像（CMRI）来调查中国有脑血管症状的患者颈动脉中 HRP 的患病率。
招募了在 2 周内出现前循环脑缺血症状和超声检查确定有颈动脉斑块的患者，并进行了 CMRI 检查。对有症状和无症状动脉的 HRP 特征进行了识别和比较。使用受试者工作特征曲线分析计算狭窄和最大管壁厚度的曲线下面积（AUC）来区分 HRP 的存在。在 1047 名入选的受试者中，CMRI 检测到的 HRP 比该队列中严重狭窄（≥50%）的患病率高近 1.5 倍（28%比 19%，<0.0001）。大约三分之二的 HRP 出现在狭窄程度<50%的动脉中。症状性颈动脉中 HRP 的患病率明显高于对侧无症状颈动脉（23.0%比 16.4%，=0.001）。最大管壁厚度是比狭窄程度更能区分 HRP 的指标（AUC：0.93 比 0.81，<0.0001）。
在有症状的中国患者中，高危颈动脉斑块的数量明显多于狭窄程度≥50%的颈动脉。大量 HRP 出现在狭窄程度较低的动脉中，最大管壁厚度是比管腔狭窄更能预测 HRP 的指标。
