Spanos Konstantinos, Petrocheilou Glykeria, Livieratos Livieris, Labropoulos Nicos, Mikhailidis Dimitri P, Giannoukas Athanasios D
Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Unit of Ultrasound, Department of Radiology, Athens KAT Hospital, Athens, Greece.
Ann Vasc Surg. 2018 Aug;51:207-216. doi: 10.1016/j.avsg.2017.11.069. Epub 2018 Feb 28.
Atherosclerosis usually develops at geometrically susceptible areas, despite the impact of systemic risk factors on the entire vascular system. The aim of our study was to investigate whether carotid bifurcation geometry as assessed by ultrasound is associated with early carotid atherosclerosis, regardless of the presence of known atherosclerotic risk factors.
A nonrandomized prospective study was undertaken, including subjects of both genders, aged 50-60 years, without known cardiovascular family history, and symptoms and/or signs of cardiovascular disease. Clinical assessment and ultrasound of the carotid bifurcation evaluating geometrical characteristics, ultrasonic biopsy score (UBS), intima-media thickness (IMT), and the presence of plaque were recorded.
Two hundred one subjects (95 men/106 women; mean age: 55 years) provided 286 carotid bifurcations associated with atherosclerotic risk factors and 114 without (one poor imaging). While UBS in the right common carotid artery (CCA) was higher in subjects with atherosclerotic risk factors but free of plaque (P = 0.035), larger diameter of the bulb (dBULB) (P < 0.001), lower ratios of internal carotid artery diameter + external carotid artery diameter/diameter of CCA ([dICA + dECA]/dCCA) (P = 0.004), and (dICA + dECA)/dCCA (P = 0.025) were independently associated with higher CCA IMT. The presence of plaque among the total 400 carotid bifurcations was associated in the left and right CCA with lower values of bulb diameter/dCCA (dBULB/dCCA) (P = 0.014) and (dICA + dECA)/dCCA (P = 0.001), respectively. Among subjects without atherosclerotic risk factors (n = 114), the presence of plaque in the right CCA was associated with lower values of (dBULB + dECA)/dCCA (P = 0.001) and that in the left with lower values of dBULB/dCCA (P = 0.001).
Different dimensional ratios of the carotid bifurcation assessed by ultrasound are associated with the development of early carotid atherosclerosis independently from the presence of atherosclerotic risk factors. Carotid atherosclerotic process may be side dependent.
尽管全身风险因素会影响整个血管系统，但动脉粥样硬化通常在几何形状易损的区域发展。我们研究的目的是调查通过超声评估的颈动脉分叉几何形状是否与早期颈动脉粥样硬化相关，而不考虑已知动脉粥样硬化风险因素的存在。
进行了一项非随机前瞻性研究，纳入年龄在50 - 60岁之间、无已知心血管家族病史且无心血管疾病症状和/或体征的男女受试者。记录了颈动脉分叉的临床评估和超声检查结果，包括几何特征、超声活检评分（UBS）、内膜中层厚度（IMT）以及斑块的存在情况。
201名受试者（95名男性/106名女性；平均年龄：55岁）提供了286个与动脉粥样硬化风险因素相关的颈动脉分叉和114个无相关因素的分叉（1个成像不佳）。在有动脉粥样硬化风险因素但无斑块的受试者中，右侧颈总动脉（CCA）的UBS较高（P = 0.035），而球部直径（dBULB）较大（P < 0.001），颈内动脉直径 + 颈外动脉直径/颈总动脉直径的比值（[dICA + dECA]/dCCA）较低（P = 0.004），且（dICA + dECA）/dCCA较低（P = 0.025）与较高的CCA IMT独立相关。在总共400个颈动脉分叉中，斑块的存在分别与左侧和右侧CCA的球部直径/CCA（dBULB/dCCA）较低值（P = 0.014）和（dICA + dECA）/dCCA较低值（P = 0.001）相关。在无动脉粥样硬化风险因素的受试者（n = 114）中，右侧CCA中斑块的存在与（dBULB + dECA）/dCCA较低值相关（P = 0.001），左侧则与dBULB/dCCA较低值相关（P = 0.001）。
通过超声评估的颈动脉分叉不同维度比值与早期颈动脉粥样硬化的发展相关，且独立于动脉粥样硬化风险因素的存在。颈动脉粥样硬化过程可能存在侧别依赖性。
