Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China.
World Neurosurg. 2020 May;137:e298-e307. doi: 10.1016/j.wneu.2020.01.181. Epub 2020 Jan 31.
The purpose of this study was to identify which stage of intraplaque hemorrhage (IPH) is an independent risk factor for ipsilateral new ischemic lesions (NILs) after carotid artery stenting (CAS).
In 268 patients treated with CAS, the association between postoperative ipsilateral NILs on diffusion-weighted imaging (DWI) and patient demographics, intraoperative factors, and plaque characteristics on multicontrast atherosclerosis characterization sequence was retrospectively analyzed.
A total of 268 patients were enrolled in the study. Ipsilateral NILs on DWI were detected in 32.8% of patients. Univariate analysis showed that the stage of IPH (along with lipid-rich necrotic core [LRNC]) (P < 0.001) in the carotid plaque, predilation (P = 0.012), stent type (P = 0.002), and aortic arch ulcer (P = 0.009) were associated with postoperative ipsilateral NILs, whereas other patient-related factors (P >0.05), type of embolic protection device (P = 0.072), postdilation (P = 0.388), calcification (P = 0.140), and LRNC (without IPH) (P = 0.086) were not. Multivariate logistic regression analysis showed that the acute and recent IPH (along with LRNC) (odds ratio [OR], 3.78, P = 0.011 and OR, 16.73, P < 0.001, respectively), aortic arch ulcer (OR, 2.46; P = 0.006), predilation (OR, 4.78; P = 0.015), and open cell stent (OR, 4.19; P < 0.001) were significantly associated with postoperative ipsilateral NILs on DWI.
Screening for recent IPH in carotid plaques using multicontrast atherosclerosis characterization sequence may identify plaques at a higher risk for cerebral embolism during CAS.
本研究旨在确定斑块内出血（IPH）的哪个阶段是颈动脉支架置入术（CAS）后同侧新缺血性病变（NIL）的独立危险因素。
回顾性分析 268 例接受 CAS 治疗的患者，分析术后扩散加权成像（DWI）显示同侧 NIL 与患者人口统计学、术中因素和多对比动脉粥样硬化特征序列斑块特征之间的关系。
共纳入 268 例患者。DWI 显示同侧 NIL 发生率为 32.8%。单因素分析显示，颈动脉斑块中 IPH 分期（伴有富含脂质的坏死核心[LRNC]）（P < 0.001）、预扩张（P = 0.012）、支架类型（P = 0.002）和主动脉弓溃疡（P = 0.009）与术后同侧 NIL 有关，而其他患者相关因素（P > 0.05）、栓塞保护装置类型（P = 0.072）、后扩张（P = 0.388）、钙化（P = 0.140）和无 IPH 的 LRNC（P = 0.086）无相关性。多因素 logistic 回归分析显示，急性和近期 IPH（伴有 LRNC）（比值比[OR]，3.78，P = 0.011 和 OR，16.73，P < 0.001）、主动脉弓溃疡（OR，2.46；P = 0.006）、预扩张（OR，4.78；P = 0.015）和开放细胞支架（OR，4.19；P < 0.001）与 DWI 显示术后同侧 NIL 显著相关。
使用多对比动脉粥样硬化特征序列筛查颈动脉斑块中的近期 IPH 可能会发现 CAS 期间发生脑栓塞风险较高的斑块。
