Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.
Eur J Neurol. 2020 May;27(5):809-816. doi: 10.1111/ene.14157. Epub 2020 Feb 16.
Plaque neovascularization is a hallmark of carotid plaque vulnerability. With contrast-enhanced ultrasound (CEUS) it is possible to visualize plaque neovessels in vivo. Our aim was to determine if CEUS-detected neovessels were associated with stroke recurrences in patients with a recent stroke and carotid atherosclerosis.
We conducted a prospective study of consecutive patients with a recent stroke and at least one atherosclerotic plaque in the internal carotid artery on the side consistent with symptoms. All of our patients underwent a carotid ultrasound examination including a CEUS study. Neovascularization was graded into three categories according to the extent of neovessels. During the follow-up, we recorded stroke recurrences. A multivariable Cox regression analysis was performed to evaluate predictors of recurrence.
We included 78 patients whose mean age was 74.3 ± 10.4 years. There were 29 (37.2%) patients with a low-grade stenosis (<50%). The remainder presented moderate (50%-69%) or high-grade (≥70%) stenosis. CEUS was not interpretable in 35.9% of the patients, mainly due to calcium shadows. We detected neovascularization in 80% of the plaques. After a median follow-up of 14.1 (interquartile range, 9.5-19.6) months, there were 15 (19.2%) stroke recurrences. In the Cox regression analysis, CEUS-detected neovascularization was independently associated with the risk of stroke recurrence, even after adjusting for the degree of stenosis (hazard ratio, 6.57; 95% confidence interval, 1.66-26.01).
In patients with an anterior circulation ischaemic stroke and carotid atherosclerosis, plaque neovascularization detected with CEUS was an independent predictor of stroke recurrence.
斑块新生血管是颈动脉斑块易损性的一个标志。应用对比增强超声（CEUS）可以在体内可视化斑块新生血管。我们的目的是确定在近期发生缺血性卒中和颈动脉粥样硬化的患者中，CEUS 检测到的新生血管是否与卒中复发有关。
我们对连续的近期发生缺血性卒中和同一侧颈内动脉至少有一个粥样硬化斑块的患者进行了前瞻性研究。所有患者均行颈动脉超声检查，包括 CEUS 检查。根据新生血管的范围将新生血管分为 3 个等级。在随访期间，我们记录了卒中复发的情况。采用多变量 Cox 回归分析评估复发的预测因素。
我们纳入了 78 名平均年龄为 74.3±10.4 岁的患者。29 名（37.2%）患者狭窄程度为低级别（<50%）。其余患者为中等级（50%-69%）或高级别（≥70%）狭窄。35.9%的患者 CEUS 结果不可解释，主要是由于钙影。我们在 80%的斑块中检测到了新生血管。中位随访 14.1（四分位间距 9.5-19.6）个月后，有 15 名（19.2%）患者发生卒中复发。在 Cox 回归分析中，即使在校正狭窄程度后，CEUS 检测到的新生血管与卒中复发的风险独立相关（风险比 6.57；95%置信区间 1.66-26.01）。
在发生前循环缺血性卒中和颈动脉粥样硬化的患者中，CEUS 检测到的斑块新生血管是卒中复发的独立预测因素。
