Department of Neurology, Nîmes University Hospital Center, University of Montpellier, Nîmes, France.
Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nîmes University Hospital Center, University of Montpellier, Nîmes, France.
Eur J Neurol. 2022 Apr;29(4):1056-1061. doi: 10.1111/ene.15229. Epub 2022 Jan 10.
Intraplaque hemorrhage is a key feature of vulnerable carotid atherosclerotic plaque (CAP), associated with low densities (<25 Hounsfield units [HU]) on computed tomographic angiography (CTA). This study aimed to analyze CAP on routine CTA performed in patients with symptomatic and asymptomatic carotid stenosis undergoing carotid endarterectomy (CEA) by assessing HU of the CAP area showing the lowest density (CAPALD) using radiological tools available in daily clinical practice, and to compare CAPALD values between symptomatic and asymptomatic carotids.
We retrospectively screened preoperative CTA scans of 206 consecutive adult patients undergoing CEA for symptomatic or asymptomatic stenosis. CAPALD values were compared between symptomatic and asymptomatic carotids. Asymptomatic carotids included arteries contralateral to the symptomatic CEA artery, and asymptomatic stenotic arteries undergoing CEA and their contralateral arteries. Carotids were excluded when there was <30% stenosis, or when CAP could not be identified or CAPALD could not be measured.
In total, 95 symptomatic and 112 asymptomatic carotids (derived from 174 patients) were analyzed. In multivariate analysis, symptomatic arteries showed more severe stenosis (median 70% vs. 67%, p = 0.0228) and lower CAPALD values (median 17 vs. 25 HU, p = 0.049), whereas degree of stenosis and CAPALD values were not correlated (rho = -0.02, p = 0.77). HU values of <25 were more frequent in symptomatic than asymptomatic carotids (68% vs. 47%, p = 0.0022).
On CTA, symptomatic carotids are associated with CAP areas with low densities. CTA analysis of CAP may be interesting to help identify vulnerable plaques at risk for future stroke, especially in patients lacking strict indications for CEA based on the current guidelines.
斑块内出血是易损颈动脉粥样硬化斑块（CAP）的一个关键特征，与计算机断层血管造影（CTA）上的低密度（<25 亨斯菲尔德单位 [HU]）有关。本研究旨在通过评估 CAP 区域的最低密度（CAPALD），分析在接受颈动脉内膜切除术（CEA）的有症状和无症状颈动脉狭窄患者的常规 CTA 上的 CAP，使用日常临床实践中可用的影像学工具，并比较有症状和无症状颈动脉之间的 CAPALD 值。
我们回顾性筛选了 206 例连续接受 CEA 的成人患者的术前 CTA 扫描，这些患者患有有症状或无症状的狭窄。比较了有症状和无症状颈动脉之间的 CAPALD 值。无症状颈动脉包括与有症状 CEA 动脉相对的动脉，以及接受 CEA 的无症状狭窄动脉及其对侧动脉。当狭窄程度<30%或无法识别 CAP 或无法测量 CAPALD 时，将颈动脉排除在外。
共分析了 95 条有症状和 112 条无症状颈动脉（来自 174 例患者）。在多变量分析中，有症状的动脉显示出更严重的狭窄（中位数 70% vs. 67%，p=0.0228）和更低的 CAPALD 值（中位数 17 vs. 25 HU，p=0.049），而狭窄程度和 CAPALD 值之间没有相关性（rho=-0.02，p=0.77）。HU 值<25 的在有症状的颈动脉中比无症状的颈动脉更常见（68% vs. 47%，p=0.0022）。
在 CTA 上，有症状的颈动脉与低密度的 CAP 区域相关。对 CAP 的 CTA 分析可能有助于识别未来发生中风风险较高的易损斑块，尤其是在当前指南中缺乏严格的 CEA 指征的患者中。
