Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Department of Neurology, Jinling Hospital, Southeast University, Nanjing, China.
J Stroke Cerebrovasc Dis. 2020 Feb;29(2):104579. doi: 10.1016/j.jstrokecerebrovasdis.2019.104579. Epub 2019 Dec 16.
Vulnerable carotid plaque is associated with cerebrovascular events. Cholesterol crystals are often seen in the atherosclerotic plaques. However, the potential role of cholesterol crystals in carotid plaques destabilization is unknown. We aimed to identify the association between cholesterol crystals and carotid plaque vulnerability.
Optical coherence tomography assessment of carotid plaque was performed in 95 patients. Clinical characteristics and plaque morphology were examined. The differences in plaque characteristics (thrombus, calcification, neovascularization, and macrophage accumulations) and clinical parameters (age, symptom, coronary heart disease, total cholesterol, triglycerides, and C-reactive protein) between patients with or without cholesterol crystals were analyzed with multivariate logistic regression.
Among 66 patients with acceptable carotid atherosclerotic optical coherence tomography images, 16 were with and 50 were without cholesterol crystals. 56.3% patients (9 of 16) with cholesterol crystals had cerebrovascular ischemic symptom related to ipsilateral internal carotid artery, whereas only 26.0% patients (13 of 50) without cholesterol crystals had symptom (OR, 3.66; 95% CI, 1.13-11.82; P = .025). 75.0% of the plaques with cholesterol crystals had concomitant macrophage accumulation (OR, 4.14; 95% CI, 1.17-14.65; P = .04). In segments with cholesterol crystals, a higher presence of calcification could be demonstrated compared to those without cholesterol crystals (62.5% versus 32.0%, P = .03). 70.0% plaques with cholesterol crystals and calcification were classified as symptomatic plaques (OR, 6.38; 95% CI, 1.46-27.91; P = .01). No association between plaque rupture and cholesterol crystals was identified. Multivariate logistic regression showed that age and macrophage accumulation were independently associated with cholesterol crystals.
Carotid atherosclerotic plaques with cholesterol crystals were more likely to have concomitant macrophage and calcification accumulations. Patients with cholesterol crystals plaque experienced more cerebrovascular symptoms. Thus, cholesterol crystals, especially together with macrophage and calcification, may serve as an important component of venerable carotid plaques.
易损颈动脉斑块与脑血管事件有关。胆固醇晶体通常可见于动脉粥样硬化斑块中。然而，胆固醇晶体在颈动脉斑块不稳定中的潜在作用尚不清楚。我们旨在确定胆固醇晶体与颈动脉斑块易损性之间的关系。
对 95 例患者进行颈动脉斑块光学相干断层扫描评估。检查了临床特征和斑块形态。使用多元逻辑回归分析了有或无胆固醇晶体的患者之间斑块特征（血栓、钙化、新生血管形成和巨噬细胞积聚）和临床参数（年龄、症状、冠心病、总胆固醇、甘油三酯和 C 反应蛋白）的差异。
在 66 例可接受的颈动脉粥样硬化光学相干断层扫描图像的患者中，16 例有胆固醇晶体，50 例无胆固醇晶体。有胆固醇晶体的 56.3%（16 例中的 9 例）患者有与同侧颈内动脉相关的脑血管缺血症状，而无胆固醇晶体的患者仅有 26.0%（50 例中的 13 例）有症状（比值比，3.66；95%置信区间，1.13-11.82；P=0.025）。有胆固醇晶体的斑块中 75.0%伴有巨噬细胞积聚（比值比，4.14；95%置信区间，1.17-14.65；P=0.04）。与无胆固醇晶体的斑块相比，在有胆固醇晶体的斑块中可以显示出更高程度的钙化（62.5%比 32.0%，P=0.03）。有胆固醇晶体和钙化的 70.0%斑块被归类为有症状的斑块（比值比，6.38；95%置信区间，1.46-27.91；P=0.01）。未发现斑块破裂与胆固醇晶体之间存在关联。多元逻辑回归显示，年龄和巨噬细胞积聚与胆固醇晶体独立相关。
有胆固醇晶体的颈动脉粥样硬化斑块更可能伴有巨噬细胞和钙化的积聚。有胆固醇晶体斑块的患者经历更多的脑血管症状。因此，胆固醇晶体，特别是与巨噬细胞和钙化一起，可能是易损颈动脉斑块的一个重要组成部分。
