颅内动脉与颅外颈动脉粥样硬化性疾病并存与同侧脑梗死的关系：中国动脉粥样硬化风险评估（CARE-II）研究。

Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE-II) study.

机构信息

Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.

Department of Radiology, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China.

出版信息

Stroke Vasc Neurol. 2021 Dec;6(4):595-602. doi: 10.1136/svn-2020-000538. Epub 2021 Apr 26.

DOI:10.1136/svn-2020-000538

PMID:33903178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8717767/

Abstract

BACKGROUND

To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct (ACI) in symptomatic patients by using magnetic resonance (MR) vessel wall imaging.

METHODS

Symptomatic patients were recruited from a cross-sectional, multicentre study of Chinese Atherosclerosis Risk Evaluation (CARE-II). All patients underwent MR imaging for extracranial carotid arterial wall, intracranial artery and brain. Coexisting intracranial stenosis ≥50% and extracranial carotid artery mean wall thickness (MWT) ≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was identified. The association between coexisting atherosclerotic diseases and ACI was evaluated using logistic regression.

RESULTS

351 patients were recruited. Patients with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis ≥50% and carotid MWT ≥1 mm (20.5% vs 4.9%, p<0.001), calcification (15.1% vs 4.4%, p=0.001) and lipid-rich necrotic core (LRNC) (19.2% vs 7.8%, p=0.002) compared with those without. Coexisting intracranial artery stenosis ≥50% and carotid MWT ≥1 mm (OR 5.043, 95% CI 2.378 to 10.694; p<0.001), calcification (OR 3.864, 95% CI 1.723 to 8.664; p=0.001) and LRNC (OR 2.803, 95% CI 1.455 to 5.401; p=0.002) were significantly associated with ipsilateral ACI. After adjusting for confounding factors, the aforementioned associations remained statistically significant (intracranial stenosis ≥50% coexisting with carotid MWT ≥1 mm: OR 4.313, 95% CI 1.937 to 9.601, p<0.001; calcification: OR 3.606, 95% CI 1.513 to 8.593, p=0.004; LRNC: OR 2.358, 95% CI 1.166 to 4.769, p=0.017).

CONCLUSIONS

Coexistence of intracranial artery severe stenosis and extracranial carotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral ACI.

TRIAL REGISTRATION NUMBER

https://www.clinicaltrials.gov/. Unique identifier: NCT02017756.

摘要

背景

通过磁共振（MR）血管壁成像评估症状性患者颅内和颅外颈动脉粥样硬化疾病并存与同侧急性脑梗死（ACI）的关系。

方法

从中国动脉粥样硬化风险评估（CARE-II）的一项横断面多中心研究中招募症状性患者。所有患者均接受颅外颈动脉壁、颅内动脉和脑的 MR 成像。评估同侧颅内狭窄≥50%和颈总动脉平均壁厚度（MWT）≥1mm和斑块成分，并确定同侧 ACI。使用逻辑回归评估并存粥样硬化疾病与 ACI 的关系。

结果

共纳入 351 例患者。同侧发生 ACI 的患者颅内狭窄≥50%和颈动脉 MWT≥1mm 的患病率显著更高（20.5%比 4.9%，p<0.001），钙化（15.1%比 4.4%，p=0.001）和富含脂质的坏死核心（LRNC）（19.2%比 7.8%，p=0.002）。与无 ACI 的患者相比。颅内动脉狭窄≥50%和颈动脉 MWT≥1mm（OR 5.043，95%CI 2.378 至 10.694；p<0.001）、钙化（OR 3.864，95%CI 1.723 至 8.664；p=0.001）和 LRNC（OR 2.803，95%CI 1.455 至 5.401；p=0.002）与同侧 ACI 显著相关。调整混杂因素后，上述关联仍具有统计学意义（颅内狭窄≥50%并存颈动脉 MWT≥1mm：OR 4.313，95%CI 1.937 至 9.601，p<0.001；钙化：OR 3.606，95%CI 1.513 至 8.593，p=0.004；LRNC：OR 2.358，95%CI 1.166 至 4.769，p=0.017）。