1Department of Neuroendovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center.
2Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center; and.
J Neurosurg. 2021 Sep 24;136(4):1029-1034. doi: 10.3171/2021.4.JNS21546. Print 2022 Apr 1.
To test the hypothesis that intraplaque hemorrhage is a predictor of restenosis after carotid artery stenting (CAS), the association between intraplaque high-intensity signal (HIS) on time-of-flight MR angiography (TOF-MRA), as a marker of intraplaque hemorrhage, and restenosis after CAS was assessed in the present observational study.
Consecutive patients who underwent initial CAS for atherosclerotic stenosis in the cervical internal carotid artery in the authors' department were enrolled. Of these, patients without preprocedural cervical TOF-MRA were excluded. Outcome measures were ≥ 50% restenosis, defined as a peak systolic velocity of > 1.3 m/sec; or occlusion and ≥ 70% restenosis, defined as a peak systolic velocity of > 2.1 m/sec; or occlusion on carotid duplex ultrasound.
Of 230 consecutive patients who underwent initial CAS, 22 without preprocedural cervical TOF-MRA were excluded. Of the remaining 208 patients (mean age 73 years; 33 women), 46 had intraplaque HIS. Ultrasound follow-up was not performed in 4 patients. The median follow-up duration was 3.2 years (interquartile range 1.7-5.1 years). During the follow-up period, 102 patients had ≥ 50% restenosis and 36 had ≥ 70% restenosis. Intraplaque HIS was significantly associated with increased risk of ≥ 50% restenosis (adjusted hazard ratio 2.18; 95% CI 1.28-3.68) and ≥ 70% restenosis (adjusted hazard ratio 3.12; 95% CI 1.32-7.52).
Intraplaque HIS on TOF-MRA was associated with increased risk of restenosis after CAS. The present results indicate that intraplaque hemorrhage is a predictor of restenosis after CAS.
检测斑块内出血（intraplaque hemorrhage）是颈动脉支架置入术（carotid artery stenting，CAS）后再狭窄的预测因子这一假说，本观察性研究评估了时间飞越磁共振血管造影（time-of-flight magnetic resonance angiography，TOF-MRA）上斑块内高强度信号（intraplaque high-intensity signal，HIS）作为斑块内出血的标志物与 CAS 后再狭窄之间的相关性。
本研究纳入了在作者所在科室因颈内动脉粥样硬化性狭窄而首次接受 CAS 的连续患者。其中，排除了无术前颈 TOF-MRA 的患者。主要转归为≥50%的再狭窄，定义为收缩期峰值流速＞1.3m/s；或闭塞和≥70%的再狭窄，定义为收缩期峰值流速＞2.1m/s；或颈动脉双功超声检查提示闭塞。
在 230 例连续接受初次 CAS 的患者中，有 22 例因无术前颈 TOF-MRA 而被排除。在剩余的 208 例患者（平均年龄 73 岁；33 例女性）中，有 46 例存在斑块内 HIS。有 4 例未进行超声随访。中位随访时间为 3.2 年（四分位距 1.7-5.1 年）。在随访期间，有 102 例患者发生了≥50%的再狭窄，有 36 例患者发生了≥70%的再狭窄。斑块内 HIS 与发生≥50%的再狭窄（校正后的风险比 2.18；95%可信区间 1.28-3.68）和≥70%的再狭窄（校正后的风险比 3.12；95%可信区间 1.32-7.52）的风险增加显著相关。
TOF-MRA 上的斑块内 HIS 与 CAS 后再狭窄的风险增加相关。本研究结果表明，斑块内出血是 CAS 后再狭窄的预测因子。
