Capital Medical University, Beijing, PR China.
Department of Ultrasound, Beijing Tiantan Hospital, Beijing, PR China.
Acta Radiol. 2022 Feb;63(2):278-286. doi: 10.1177/0284185121989189. Epub 2021 Feb 1.
Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice.
To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis.
A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves.
From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26-7.12, = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77-5.89, <0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47-11.55, = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77-0.92) and the Hosmer-Lemeshow test value was 0.822.
In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.
无症状颈动脉斑块的风险分层在临床实践中的卒中预防中仍然是一个问题。
研究多模态超声（MMU）模型是否有助于无症状颈动脉狭窄患者的斑块风险分层。
对有症状和无症状的近端颈内动脉（ICA）＞50%狭窄的患者进行前瞻性研究。所有患者均接受 MMU 检查。采用多变量回归分析确定与缺血性血管事件（IVE）相关的参数。这些参数用于开发评分诺模图来评估 IVE 的概率。我们使用受试者工作特征（ROC）曲线详细阐述了 MMU 诺模图的诊断性能。
2018 年 12 月至 2019 年 12 月，共纳入 98 例患者（75 例男性，平均年龄 67±8 岁）；50 例有症状，48 例无症状。多变量回归分析显示斑块表面形态（PSM）（比值比 [OR] 2.99，95%置信区间 [CI] 1.26-7.12， = 0.013）、斑块内新生血管（IPN）分级（OR 3.23，95% CI 1.77-5.89，<0.001）和颈动脉狭窄程度（CSD）（OR 4.12，95% CI 1.47-11.55， = 0.007）与 IVE 独立相关。对于诺模图，ROC 曲线下面积为 0.85（95%CI 0.77-0.92），Hosmer-Lemeshow 检验值为 0.822。
在近端 ICA＞50%的患者中，PSM、IPN 分级和 CSD 是与 IVE 相关的独立变量。MMU 诺模图为 IVE 的风险分层提供了有利的价值。需要进一步进行大规模的长期随访研究来验证这些发现。
