Watase Hiroko, Canton Gador, Sun Jie, Zhao Xihai, Hatsukami Thomas S, Yuan Chun
Department of Surgery, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
Diagnostics (Basel). 2019 Oct 2;9(4):137. doi: 10.3390/diagnostics9040137.
Correct stratification of ischemic stroke risk allows for the proper treatment of carotid atherosclerotic disease. We seek to differentiate plaque types based on stenosis level and plaque morphology. The Chinese Atherosclerosis Risk Evaluation (CARE-II) study is a cross-sectional, observational, multicenter study to assess carotid atherosclerotic plaques in symptomatic subjects using vessel wall magnetic resonance imaging. Plaque morphology and presence of plaque components were reviewed using multi-contrast magnetic resonance imaging. The carotid arteries were divided into four groups based on stenosis level and plaque components. Out of 1072 ischemic stroke subjects, 452 ipsilateral side carotid arteries were included. Significant stenosis (SS) (≥50% stenosis) with high-risk plaque (HRP) features was present in 37 arteries (8.2%), SS(+)/HRP(-) in 29 arteries (6.4%), SS(-)/HRP(+) in 57 arteries (12.6%), and SS(-)/HRP(-) in 329 arteries (72.8%). The prevalence of SS(-)/HRP(+) arteries in this cohort was substantial and had greater wall thickness than the SS(+)/HRP(-) group. These arteries may be misclassified for carotid revascularization by current guidelines based on the degree of luminal stenosis only. These findings have implications for further studies to assess stroke risk using vessel wall imaging.
准确分层缺血性中风风险有助于对颈动脉粥样硬化疾病进行恰当治疗。我们试图根据狭窄程度和斑块形态来区分斑块类型。中国动脉粥样硬化风险评估（CARE-II）研究是一项横断面、观察性、多中心研究，旨在使用血管壁磁共振成像评估有症状受试者的颈动脉粥样硬化斑块。使用多对比磁共振成像对斑块形态和斑块成分的存在情况进行评估。根据狭窄程度和斑块成分将颈动脉分为四组。在1072名缺血性中风受试者中，纳入了452条同侧颈动脉。37条动脉（8.2%）存在具有高危斑块（HRP）特征的显著狭窄（SS）（狭窄≥50%），29条动脉（6.4%）为SS(+)/HRP(-)，57条动脉（12.6%）为SS(-)/HRP(+)，329条动脉（72.8%）为SS(-)/HRP(-)。该队列中SS(-)/HRP(+)动脉的患病率相当高，且其管壁厚度大于SS(+)/HRP(-)组。仅根据管腔狭窄程度，这些动脉可能会被当前指南错误分类为颈动脉血运重建的对象。这些发现对使用血管壁成像评估中风风险的进一步研究具有启示意义。
