Lee Jinseong, Kil Jinsang, Kim Dae-Won, Kang Sung-Don
Institute of Wonkwang Medical Science, Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2017 Dec;19(4):291-300. doi: 10.7461/jcen.2017.19.4.291. Epub 2017 Dec 31.
Measurement of the degree of stenosis is not enough to decide on the treatment strategy for patients with carotid stenosis. Plaque morphology examination is needed for such a decision-making. Thus, we evaluated the usefulness of plaque magnetic resonance imaging (MRI) to decide on the modality of treatment for patients with carotid atherosclerotic plaques.
Fifteen patients presenting with carotid stenosis between 2014 and 2016 were included. They underwent angiography for measurement of the degree of stenosis. Carotid plaques were visualized using MRI.
There were six (40%) stable and nine (60%) unstable plaques. Seven symptomatic patients (77.7%) had unstable lesions and two symptomatic patients (33.3%) had stable lesions ( = 0.096). There were six (40%) intraplaque hemorrhage (IPH) cases. There were six symptomatic patients (100%) in the IPH group and three symptomatic patients (33.3%) in the non-IPH group ( = 0.013). The mean stenosis degree was 58.9% in the IPH group and 70.4% in the non-IPH group ( = 0.094). Symptoms occurred irrespective of the degree of the stenosis in the IPH groups. In the IPH group, the recurrent ischemic cerebrovascular event rate was 33.3%. Particularly, the recurrent ischemic cerebrovascular event rate was 66.7% in the IPH group with mild stenosis treated with medications.
IPH in plaque MRI is significantly associated with ischemic symptoms and has a high risk for subsequent ischemic cerebrovascular events irrespective of the degree of stenosis. Plaque MRI is a useful tool in predicting symptomatic risks for carotid stenosis irrespective of the degree of such stenosis.
测量狭窄程度不足以决定颈动脉狭窄患者的治疗策略。做出此类决策需要进行斑块形态学检查。因此，我们评估了斑块磁共振成像（MRI）在决定颈动脉粥样硬化斑块患者治疗方式方面的实用性。
纳入2014年至2016年间出现颈动脉狭窄的15例患者。他们接受了血管造影以测量狭窄程度。使用MRI观察颈动脉斑块。
有6个（40%）稳定斑块和9个（60%）不稳定斑块。7例有症状患者（77.7%）有不稳定病变，2例有症状患者（33.3%）有稳定病变（P = 0.096）。有6例（40%）斑块内出血（IPH）病例。IPH组有6例有症状患者（100%），非IPH组有3例有症状患者（33.3%）（P = 0.013）。IPH组的平均狭窄程度为58.9%，非IPH组为70.4%（P = 0.094）。IPH组无论狭窄程度如何均出现症状。在IPH组中，复发性缺血性脑血管事件发生率为33.3%。特别是，药物治疗的轻度狭窄IPH组的复发性缺血性脑血管事件发生率为66.7%。
斑块MRI中的IPH与缺血症状显著相关，且无论狭窄程度如何，后续发生缺血性脑血管事件的风险都很高。无论颈动脉狭窄程度如何，斑块MRI都是预测其症状性风险的有用工具。
