Hamada Saori, Kashiwazaki Daina, Yamamoto Shusuke, Akioka Naoki, Kuwayama Naoya, Kuroda Satoshi
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3599-3604. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.031. Epub 2018 Sep 13.
Recent clinical studies have recently demonstrated a strong association between carotid artery stenosis and coronary artery disease (CAD). However, the clinical impact of carotid plaque composition on CAD remains unclear. This study was aimed to determine the relationship between carotid plaque composition and CAD in patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS).
This prospective cohort study included a total of 97 patients who were admitted to our institution between January 2012 and April 2016. Magnetic resonance (MR) imaging was performed to semi-quantitatively analyze the components of carotid plaques by calculating the ratio of plaque intensity to muscle intensity on T1-weighted image. Diagnosis of CAD was based on patient history and clinical examinations during preoperative, postoperative and follow-up periods. Multivariate logistic analysis was performed to determine the risk factors for CAD. The relationship between contralateral plaque composition and CAD was also investigated.
Of 97 patients, 33 were diagnosed as having 44 episodes of CAD. Multivariate logistic analysis revealed that ASO (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.8-18.9), contralateral carotid occlusive disease (OR, 6.5; 95%CI, 1.7-22.9), and plaque/muscle ratio (OR, 3.0; 95%CI, 1.4-10.1) were independent factors for predicting CAD. The patients diagnosed as having CAD during the follow-up period had significantly higher plaque/muscle ratio than those with CAD on preoperative evaluations (2.29 ± .21vs. 1.97 ± .33, P < .01).
This study clearly demonstrates that ASO, contralateral carotid artery stenosis, and high-intensity carotid plaque on T1-weighted MRI independently predict CAD. Contralateral carotid plaque composition was also associated with concomitant CAD. Moreover, high-intensity carotid plaque may predict the future development of CAD. Therefore, unstable carotid plaque should be considered as the clinical phenotype of systemic inflammation and a novel, robust marker for future CAD.
近期临床研究表明颈动脉狭窄与冠状动脉疾病（CAD）之间存在密切关联。然而，颈动脉斑块成分对CAD的临床影响仍不明确。本研究旨在确定接受颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）的患者中颈动脉斑块成分与CAD之间的关系。
这项前瞻性队列研究共纳入了2012年1月至2016年4月期间入住我院的97例患者。通过计算T1加权图像上斑块强度与肌肉强度的比值，采用磁共振（MR）成像对颈动脉斑块成分进行半定量分析。CAD的诊断基于患者术前、术后及随访期间的病史和临床检查。进行多因素逻辑分析以确定CAD的危险因素。同时还研究了对侧斑块成分与CAD之间的关系。
97例患者中，33例被诊断为发生44次CAD发作。多因素逻辑分析显示，急性脑梗死（优势比[OR]，5.7；95%置信区间[CI]，1.8 - 18.9）、对侧颈动脉闭塞性疾病（OR，6.5；95%CI，1.7 - 22.9）以及斑块/肌肉比值（OR，3.0；95%CI，1.4 - 10.1）是预测CAD的独立因素。随访期间被诊断为CAD的患者其斑块/肌肉比值显著高于术前评估为CAD的患者（2.29±0.21对1.97±0.33，P < 0.01）。
本研究清楚地表明，急性脑梗死、对侧颈动脉狭窄以及T1加权MRI上的高强度颈动脉斑块可独立预测CAD。对侧颈动脉斑块成分也与伴发的CAD相关。此外，高强度颈动脉斑块可能预测CAD的未来发展。因此，不稳定的颈动脉斑块应被视为全身炎症的临床表型以及未来CAD的一种新的、可靠的标志物。
