Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA,
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA,
Cerebrovasc Dis. 2020;49(4):355-360. doi: 10.1159/000508733. Epub 2020 Jul 16.
Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied.
A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH.
Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipidemia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p <0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009).
IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.
斑块内出血（IPH）是已知的与有症状的颈内颈动脉疾病相关的预测因子。然而，IPH 与可改变的心血管危险因素、患者人口统计学和相关实验室值之间的关联尚未得到广泛研究。
对过去 3 年期间进行专门颈动脉斑块成像的连续患者进行了回顾性分析。如果磁共振检查不包括高分辨率颈动脉斑块成像，则排除患者。颈动脉斑块图像上的斑块内高信号被认为代表 IPH。将 IPH 的存在与否与各种人口统计学和临床变量进行了比较。进行了多变量回归分析，以确定变量与 IPH 之间的独立关联。
在 643 名纳入的患者中，114 名（17.7%）患者在一条或两条颈动脉中存在 IPH，529 名（82.3%）患者不存在；有 IPH 的患者中有 39.5%患有冠状动脉疾病，而没有 IPH 的患者中有 23.1%（p = 0.0003）。有 IPH 的患者中高血压（77.2%比 60.7%，p = 0.009）、高脂血症（89.5%比 62.4%，p < 0.0001）、糖尿病（29.0%比 18.7%，p = 0.01）和吸烟史（63.2%比 52.6%，p = 0.003）的比例更高。没有 IPH 的患者的高密度脂蛋白水平平均较高（46.1%比 56.7%，p = 0.003）。与 IPH 相关的独立因素包括年龄较大（优势比[OR]：1.1，95%置信区间[CI]：[1.0-1.05]，p <0.0001）、男性（OR：2.5，95% CI：[1.4-4.4]，p = 0.0001）、颈动脉狭窄（OR：8.4，95% CI：[4.6-15.3]，p <0.0001）和高脂血症（OR：2.6，95% CI：[1.3-5.2]，p = 0.009）。
IPH 与多种心血管危险因素相关，特别是年龄较大、男性、颈动脉狭窄和高脂血症。这些危险因素可能在 IPH 的发展中起作用，并可能深入了解不稳定颈动脉斑块的病理生理学。
