Ravikanth Reddy
Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India.
J Med Ultrasound. 2019 Jul 12;28(1):29-34. doi: 10.4103/JMU.JMU_5_19. eCollection 2020 Jan-Mar.
Carotid atherosclerosis is not only a marker of systemic atherosclerosis but also a predictor of ischemic stroke. The purpose of this study is to correlate the relationship between atherosclerotic risk factors, plaque categories, percentage of stenosis, stroke subtypes, and carotid intima-media thickness (CIMT) in patients with acute ischemic stroke.
This case-control study was conducted over 4 years from December 2014 to December 2018. A total of 500 cases diagnosed with acute cerebral infarct using computed tomography or magnetic resonance imaging were included in the study. Two hundred and fifty healthy controls were studied for the presence of atherosclerotic risk factors and carotid artery IMT by B-mode Doppler ultrasonography. The IMT value thus calculated was 0.79 mm and such a value would include >95% of the controls. Carotid plaques were detected from both sides of IMT measurement of the carotid system.
A total of 500 cases of acute infarct and 250 healthy controls were included in this case-control study. CIMT was abnormal in 348 cases with 192 males and 156 females with a mean value of 0.912 ± 0.124 against 0.794 ± 0.132; < 0.001 controls. Mean CIMT (averaged right and left) varied directly according to the increasing plaque stenosis ranging from 0.70 mm to 0.96 mm in males and 0.68 mm to 0.94 mm in females ranging from no plaque to cases with ≥50% stenosis ( < 0.001 across stenosis categories). On multivariate analysis, CIMT (>0.79) remained associated as compared to other variables (PR [Probability] 5.33, 95% confidence interval: 1.398-22.784; = 0.012). Mean right CIMT of patients with lacunar infarction, cardioembolism, and large artery stroke was 0.886 ± 0.230, 0.919 ± 0.171, and 0.938 ± 0.169 mm, respectively ( = 0.032). Mean left CIMT of patients with lacunar infarction, cardioembolism, and large artery stroke was 0.884 ± 0.195, 0.916 ± 0.144, and 0.930 ± 0.137 mm, respectively ( = 0.034).
CIMT measurements are independent markers of acute ischemic cerebral infarcts. In the current study, CIMT was found to be higher among acute ischemic stroke patients who were the elderly, smoker, hypertensive, diabetic, and hypercholesterolemic than that of nonsmoker, normotensive, nondiabetic, and normocholesterolemic controls.
颈动脉粥样硬化不仅是全身动脉粥样硬化的一个标志，也是缺血性卒中的一个预测指标。本研究的目的是关联急性缺血性卒中患者的动脉粥样硬化危险因素、斑块类别、狭窄百分比、卒中亚型与颈动脉内膜中层厚度（CIMT）之间的关系。
本病例对照研究从2014年12月至2018年12月进行了4年。共有500例经计算机断层扫描或磁共振成像诊断为急性脑梗死的病例纳入研究。通过B型多普勒超声对250名健康对照者进行动脉粥样硬化危险因素和颈动脉内膜中层厚度的研究。由此计算出的内膜中层厚度值为0.79毫米，该值涵盖了超过95%的对照者。从颈动脉系统内膜中层厚度测量的两侧检测颈动脉斑块。
本病例对照研究共纳入500例急性梗死病例和250名健康对照者。348例患者的CIMT异常，其中男性192例，女性156例，平均值为0.912±0.124，而对照者为0.794±0.132；P<0.001。平均CIMT（左右侧平均值）随着斑块狭窄程度的增加而直接变化，男性从无斑块到狭窄≥50%的病例，范围从0.70毫米到0.96毫米，女性从0.68毫米到0.94毫米（各狭窄类别间P<0.001）。多因素分析显示，与其他变量相比，CIMT（>0.79）仍然具有相关性（PR[概率]5.33，95%置信区间：1.398 - 22.784；P = 0.012）。腔隙性梗死、心源性栓塞和大动脉卒中患者的右侧平均CIMT分别为0.886±0.230、0.919±0.171和0.938±0.169毫米（P = 0.032）。腔隙性梗死、心源性栓塞和大动脉卒中患者的左侧平均CIMT分别为0.884±0.195、0.916±0.144和0.930±0.137毫米（P = 0.034）。
CIMT测量是急性缺血性脑梗死的独立标志物。在本研究中，发现老年、吸烟、高血压病、糖尿病和高胆固醇血症的急性缺血性卒中患者的CIMT高于非吸烟、血压正常、非糖尿病和胆固醇正常的对照者。
