Yang Qingwen, Guo Hongquan, Shi Xuan, Xu Xiaohui, Zha Mingming, Cai Haodi, Yang Dahong, Huang Feihong, Zhang Xiaohao, Lv Qiushi, Liu Rui, Liu Xinfeng
Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.
Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.
Front Neurosci. 2021 Dec 10;15:792437. doi: 10.3389/fnins.2021.792437. eCollection 2021.
Symptomatic carotid disease conveys a high risk of recurrent stroke. Plaque morphology and specific plaque characteristics are associated with the risk of stroke. This study aimed to evaluate the detailed plaque features by optical coherence tomography (OCT) and develop a simple scale combining clinical indicators, digital subtraction angiography (DSA), and OCT imaging markers to identify symptomatic carotid plaque. Carotid plaques from consecutive patients who underwent carotid OCT imaging between June 2017 and June 2021 were evaluated. Clinical characteristics, DSA, and OCT data were compared between the symptomatic and asymptomatic groups. Logistic regression was performed to identify the factors associated with symptomatic carotid plaque and to develop a scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the scale. A total of 90 carotid plaques from 90 patients were included (symptomatic 35.6%, asymptomatic 64.4%). Three main factors were found to be associated with symptomatic carotid plaque: high-density lipoprotein cholesterol (HDL-C) <0.925 mmol/L (OR, 4.708; 95% CI, 1.640 to 13.517; = 0.004), irregular plaque (OR, 4.017; 95% CI, 1.250 to 12.910; = 0.020), and white thrombus (OR, 4.594; 95% CI, 1.141 to 18.487; = 0.032). The corresponding score of three items produced a scale with good discrimination (AUC, 0.768; 95% CI, 0.665 to 0.871). The optimal cutoff value of the scale was 1.5 points with 59.4% sensitivity and 84.5% specificity. The three-item scale comprising HDL-C <0.925 mmol/L, angiographical irregular plaque, and white thrombus detected by OCT may provide information to identify symptomatic carotid plaque. Further large-scale studies are required to validate whether the symptomatic carotid plaque scale is clinically valuable in recognizing carotid atherosclerosis in the early stages.
有症状的颈动脉疾病会带来较高的复发性中风风险。斑块形态和特定的斑块特征与中风风险相关。本研究旨在通过光学相干断层扫描（OCT）评估详细的斑块特征，并制定一个结合临床指标、数字减影血管造影（DSA）和OCT成像标志物的简单量表，以识别有症状的颈动脉斑块。对2017年6月至2021年6月期间接受颈动脉OCT成像的连续患者的颈动脉斑块进行评估。比较有症状组和无症状组的临床特征、DSA和OCT数据。进行逻辑回归以确定与有症状颈动脉斑块相关的因素并制定一个量表。使用受试者操作特征曲线（AUC）下的面积来评估该量表的性能。共纳入90例患者的90个颈动脉斑块（有症状的占35.6%，无症状的占64.4%）。发现与有症状颈动脉斑块相关的三个主要因素：高密度脂蛋白胆固醇（HDL-C）<0.925 mmol/L（OR，4.708；95%CI，1.640至13.517；P = 0.004）、斑块不规则（OR，4.017；95%CI，1.250至12.910；P = 0.020）和白色血栓（OR，4.594；95%CI，1.141至18.487；P = 0.032）。这三项的相应得分产生了一个具有良好区分度的量表（AUC，0.768；95%CI，0.665至0.871）。该量表的最佳截断值为1.5分，灵敏度为59.4%，特异性为84.5%。由HDL-C< 0.925 mmol/L、血管造影显示的不规则斑块和OCT检测到的白色血栓组成的三项量表可能为识别有症状的颈动脉斑块提供信息。需要进一步的大规模研究来验证有症状颈动脉斑块量表在早期识别颈动脉粥样硬化方面是否具有临床价值。
