Donners Simone J A, Toorop Raechel J, de Kleijn Dominique P V, de Borst Gert J
Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Ann Transl Med. 2021 Aug;9(15):1260. doi: 10.21037/atm-21-1166.
In this narrative review, we aim to review imaging biomarkers that carry the potential to non-invasively guide stroke risk stratification for treatment optimization.
Carotid atherosclerosis plays a fundamental part in the occurrence of ischemic stroke. International guidelines select the optimal treatment strategy still mainly based on the presence of clinical symptoms and the degree of stenosis for stroke prevention in patients with atherosclerotic carotid plaques. These guidelines, based on randomized controlled trials that were conducted three decades ago, recommend carotid revascularization in symptomatic patients with high degree of stenosis versus a conservative approach for most asymptomatic patients. Due to optimization of best medical therapy and risk factor control, it is suggested that a subgroup of symptomatic patients is at lower risk of stroke and may not benefit from revascularization, whereas a selective subgroup of high-risk asymptomatic patients would benefit from this procedure.
A literature search was performed for articles published up to December 2020 using PubMed, EMBASE and Scopus. Based on the literature found, change in stenosis degree and volume, plaque echolucency, plaque surface, intraplaque haemorrhage, lipid-rich necrotic core, thin fibrous cap, inflammation, neovascularization, microembolic signals, cerebrovascular reserve, intracranial collaterals, silent brain infarcts, diffusion weighted imaging lesions and white matters lesions have the potential to predict stroke risk.
The applicability of imaging biomarkers needs to be further improved before the potential synergistic prognostic ability of imaging biomarkers can be verified on top of the clinical biomarkers. In the future, the routine and combined assessment of both plaque and brain imaging biomarkers might help to improve optimization of treatment strategies in individual patients with atherosclerotic carotid artery disease.
在本叙述性综述中，我们旨在回顾具有非侵入性指导中风风险分层以优化治疗潜力的影像学生物标志物。
颈动脉粥样硬化在缺血性中风的发生中起重要作用。国际指南在选择最佳治疗策略时，仍主要基于临床症状的存在以及动脉粥样硬化性颈动脉斑块患者中风预防的狭窄程度。这些基于三十年前进行的随机对照试验的指南建议，有症状的高度狭窄患者进行颈动脉血运重建，而大多数无症状患者则采取保守方法。由于最佳药物治疗和危险因素控制的优化，有人提出，一部分有症状的患者中风风险较低，可能无法从血运重建中获益，而一小部分高危无症状患者则会从该手术中获益。
使用PubMed、EMBASE和Scopus对截至2020年12月发表的文章进行文献检索。根据所发现的文献，狭窄程度和体积的变化、斑块回声、斑块表面、斑块内出血、富含脂质的坏死核心、薄纤维帽、炎症、新生血管形成、微栓塞信号、脑血管储备、颅内侧支循环、无症状脑梗死、扩散加权成像病变和白质病变有可能预测中风风险。
在影像学生物标志物的潜在协同预后能力在临床生物标志物之上得到验证之前，其适用性需要进一步提高。未来，对斑块和脑影像学生物标志物进行常规和联合评估可能有助于改善个体动脉粥样硬化性颈动脉疾病患者治疗策略的优化。
