Ji Aihua, Lv Peng, Dai Yuanyuan, Bai Xueqin, Tang Xiao, Fu Caixia, Lin Jiang
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Int J Cardiovasc Imaging. 2019 Jun;35(6):1047-1054. doi: 10.1007/s10554-018-01521-5. Epub 2019 Apr 25.
The risk of cerebral embolism after CAS in patients with carotid IPH is still controversial. This study was to further investigate the relationship between IPH and new ipsilateral ischemic lesion (NIIL) after CAS, and to perform a volumetric analysis of IPH for predicting the risk of NIIL following CAS. One hundred and seventeen patients with carotid stenosis undergoing CAS were prospectively enrolled. Preprocedural multi-contrast carotid MRI was performed. NIIL was evaluated by brain DWI before and after CAS. IPH volume, wall volume at the plaque (WV) and relative IPH volume were calculated. Associations between IPH and postprocedural NIIL were studied. NIILs were shown in 52 patients. IPH were identified in 53 patients. NIILs were found more frequently in IPH-positive (33/53, 62.3%) than in IPH-negative patients (19/64, 29.7%, p < 0.001). There was no significant difference of WV between NIIL-positive and NIIL-negative patients (1166.6 ± 432.0 mm vs 1124.6 ± 410.4 mm, p = 0.592). The IPH volume from NIIL-positive group was significantly larger than that of NIIL-negative group (252.8 ± 264.9 mm vs 59.3 ± 131.1 mm, p < 0.001), with also higher relative IPH volume (20.4 ± 19.1% vs 5.7 ± 12.2%, p < 0.001). ROC curve showed that 183.45 mm of the IPH volume was the most reliable cutoff value for predicting NIIL with a specificity of 92.3% and a positive predictive value of 86.1%. Larger IPH volume is associated with increased risk of NIIL after CAS procedure. Quantification of IPH volume may be useful for predicting cerebral ischemic events after CAS.
颈动脉粥样硬化性斑块内出血（IPH）患者行颈动脉支架置入术（CAS）后发生脑栓塞的风险仍存在争议。本研究旨在进一步探讨IPH与CAS术后同侧新发缺血性病变（NIIL）之间的关系，并对IPH进行体积分析以预测CAS术后NIIL的风险。前瞻性纳入117例行CAS的颈动脉狭窄患者。术前进行多对比颈动脉磁共振成像（MRI）检查。通过CAS术前和术后的脑部弥散加权成像（DWI）评估NIIL。计算IPH体积、斑块处管壁体积（WV）和相对IPH体积。研究IPH与术后NIIL之间的关联。52例患者出现NIIL。53例患者发现有IPH。IPH阳性患者中NIIL的发生率（33/53，62.3%）高于IPH阴性患者（19/64，29.7%，p＜0.001）。NIIL阳性和NIIL阴性患者的WV无显著差异（1166.6±432.0 mm对1124.6±410.4 mm，p = 0.592）。NIIL阳性组的IPH体积显著大于NIIL阴性组（252.8±264.9 mm对59.3±131.1 mm，p＜0.001），相对IPH体积也更高（20.4±19.1%对5.7±12.2%，p＜0.001）。ROC曲线显示，IPH体积为183.45 mm是预测NIIL最可靠的临界值，特异性为92.3%，阳性预测值为86.1%。较大的IPH体积与CAS术后NIIL风险增加相关。IPH体积定量分析可能有助于预测CAS术后的脑缺血事件。
