Lv Peng, Ji Aihua, Zhang Ranying, Guo Daqiao, Tang Xiao, Lin Jiang
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2669-2676. doi: 10.21037/qims-20-1244.
The relationship between plaque calcification and new ischemic brain lesions after carotid artery stenting (CAS) remains controversial. The purpose of this study was to determine if the circumferential degree of carotid calcification is associated with new ischemic brain lesions on diffusion-weighted imaging (DWI) after CAS.
A total of 96 patients with carotid stenosis of ≥50% who underwent CAS were enrolled in the study. All patients underwent preoperative carotid computed tomography (CT), and preoperative and postoperative brain MRI. The brain MRI sequences included T1WI, T2WI, T2-fluid-attenuated inversion recovery (FLAIR), and DWI. The location, circumferential degree, volume, percentage volume, maximum density, mean density, Agatston score of carotid calcification, and total plaque volume were assessed and compared between patients with and without new ischemic brain lesions after CAS. Univariate and multivariate analyses were performed to evaluate predictors of new ischemic brain lesions.
All of the 96 patients (67.8±6.8 years of age, 83.3% men) were included in the analysis. New ischemic brain lesions on DWI were observed in 40 patients (41.7%). Patients with new ischemic brain lesions after CAS had a larger circumferential degree of calcification than those without new ischemic brain lesions (P<0.001). There was only a possible trend toward significance for the percentage volume of calcification between the two groups with and without new brain ischemic lesions (P=0.07). No significant differences were found regarding the location (P=0.18), volume (P=0.37), maximum density (P=0.44), mean density (P=0.39), Agatston score (P=0.28), and total plaque volume (P=0.33) of carotid calcification between the DWI+ and DWI- groups. In the multivariate analysis, an increased risk of new ischemic brain lesions was observed in patients with a high score for the circumferential degree of calcification [score 3; odds ratio (OR): 10.7, P<0.001; score 4, OR: 11.7, P=0.038].
The circumferential degree of carotid calcification was associated with new ischemic brain lesions after CAS. CAS should be avoided if possible for carotid stenosis with large circumferential calcified plaques.
颈动脉支架置入术（CAS）后斑块钙化与新发缺血性脑损伤之间的关系仍存在争议。本研究的目的是确定颈动脉钙化的圆周程度是否与CAS后弥散加权成像（DWI）上的新发缺血性脑损伤相关。
本研究共纳入96例颈动脉狭窄≥50%且接受CAS的患者。所有患者均接受术前颈动脉计算机断层扫描（CT）以及术前和术后脑部磁共振成像（MRI）检查。脑部MRI序列包括T1加权成像（T1WI）、T2加权成像（T2WI）、T2液体衰减反转恢复序列（FLAIR）和DWI。评估并比较CAS后有或无新发缺血性脑损伤患者的颈动脉钙化的位置、圆周程度、体积、体积百分比、最大密度、平均密度、阿加斯顿评分以及总斑块体积。进行单因素和多因素分析以评估新发缺血性脑损伤的预测因素。
96例患者（年龄67.8±6.8岁，男性占83.3%）均纳入分析。40例患者（41.7%）在DWI上观察到新发缺血性脑损伤。CAS后有新发缺血性脑损伤的患者钙化的圆周程度大于无新发缺血性脑损伤的患者（P<0.001）。有或无新发脑缺血性损伤的两组之间，钙化体积百分比仅存在可能的显著趋势（P=0.07）。DWI阳性组和DWI阴性组之间，在颈动脉钙化的位置（P=0.18）、体积（P=0.37）、最大密度（P=0.44）、平均密度（P=0.39）、阿加斯顿评分（P=0.28）和总斑块体积（P=0.33）方面未发现显著差异。在多因素分析中，钙化圆周程度评分高的患者发生新发缺血性脑损伤的风险增加[评分3；比值比（OR）：10.7，P<0.001；评分4，OR：11.7，P=0.038]。
颈动脉钙化的圆周程度与CAS后新发缺血性脑损伤相关。对于伴有大圆周钙化斑块的颈动脉狭窄，应尽可能避免行CAS。
