Zhu Yi-Cheng, Jiang Xiao-Zhen, Bai Qing-Ke, Deng Shu-Hao, Zhang Yuan, Zhang Zhi-Peng, Jiang Quan
Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
Department of Internal Medicine, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):830-837. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.027. Epub 2018 Dec 15.
The present study aimed to explore the efficacy of atorvastatin on patients with carotid plaque, applying superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) for evaluating carotid intraplaque neovascularization.
A total of 82 patients (82 carotid plaques) who were randomized into treatment group and control group underwent conventional ultrasound, CEUS, and SMI examinations. Patients in treatment group received a dose of 20 mg atorvastatin per day for 6 months while those in control group received placebo instead. Lipid parameters were assessed and intraplaque neovascularization were evaluated by CEUS and SMI before and 6 months after atorvastatin treatment.
No significant differences were found between the 2 groups at the study entry. Patients with atorvastatin treatment received marked improvement in total cholesterol, triglyceride, and LDL-cholesterol compared with those in control group (P < .001). In treatment group, SMI-detected intraplaque neovascularization reduced from 69.23% to 48.72% while CEUS-detected ones reduced from 76.92% to 69.23%. By contrast, the percentage of intraplaque neovascularization in control group did not change too much either by SMI (65.12%, 67.44%) or CEUS (74.41%, 74.41%). The consistency between CEUS and SMI was above .75 at all assessments (P < .001).
Atorvastatin treatment works for patients with carotid plaque by reducing LDL-cholesterol and improving plaque regression. Second, the consistency between SMI and CEUS in visualizing intraplaque neovascularization is good. That indicates a high possibility to identify carotid plaque instability by a safer and cheaper ultrasonography without contrast agent.
本研究旨在探讨阿托伐他汀对颈动脉斑块患者的疗效，应用超微血管成像（SMI）和超声造影（CEUS）评估颈动脉斑块内新生血管形成。
将82例患者（82个颈动脉斑块）随机分为治疗组和对照组，进行常规超声、CEUS和SMI检查。治疗组患者每天服用20mg阿托伐他汀，持续6个月，而对照组患者服用安慰剂。在阿托伐他汀治疗前和治疗6个月后，评估血脂参数，并通过CEUS和SMI评估斑块内新生血管形成情况。
两组在研究开始时无显著差异。与对照组相比，阿托伐他汀治疗的患者总胆固醇、甘油三酯和低密度脂蛋白胆固醇有显著改善（P <.001）。在治疗组中，SMI检测到的斑块内新生血管形成从69.23%降至48.72%，而CEUS检测到的从76.92%降至69.23%。相比之下，对照组中无论是通过SMI（65.12%，67.44%）还是CEUS（74.41%，74.41%）检测到的斑块内新生血管形成百分比变化也不大。在所有评估中，CEUS和SMI之间的一致性均高于.75（P <.001）。
阿托伐他汀治疗可通过降低低密度脂蛋白胆固醇和改善斑块消退对颈动脉斑块患者有效。其次，SMI和CEUS在显示斑块内新生血管形成方面的一致性良好。这表明通过更安全、更便宜的无造影剂超声检查来识别颈动脉斑块不稳定性的可能性很高。
