Department of Radiology and Nuclear Medicine (D.H.K.v.D.-N., N.C.M.v.E., K.D., A.v.d.L., D.B.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Neurology (D.H.K.v.D.-N., P.J.K.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
Stroke. 2022 Feb;53(2):370-378. doi: 10.1161/STROKEAHA.121.036564. Epub 2022 Jan 5.
Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes.
We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics.
We found significant difference in total plaque volume between men and women (β=22.9 mm [95% CI, 15.4-30.5]; mean volume in men 1399±425 mm, in women 1011±242 mm). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3-6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2-4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2-7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1-5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2-8.6]).
In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01208025.
男性和女性的缺血性脑卒中发病率不同，男性发病率明显更高。这种差异的潜在机制仍知之甚少，但可能是由于颈动脉粥样硬化的差异所致。我们采用一种深入的基于影像学的方法，研究了男性和女性脑卒中患者颈动脉斑块成分和形态的差异，同时考虑了总斑块负担的差异。此外，我们还研究了动脉内所有可能的斑块特征组合，以探讨各种斑块表型之间的差异。
我们纳入了来自 PARISK（斑块风险）研究的 156 名男性和 68 名女性患者，这是一项针对近期缺血性脑血管症状和同侧颈动脉狭窄<70%的患者的前瞻性队列研究。使用磁共振成像和多排螺旋 CT 血管造影评估斑块特征（斑块内出血[IPH]、富含脂质的坏死核心[LRNC]、钙化、薄或破裂的纤维帽、溃疡、总斑块体积）。我们使用多变量逻辑和线性回归分析来评估性别与斑块特征之间的差异。
我们发现男性和女性之间的总斑块体积存在显著差异（β=22.9 mm [95%置信区间，15.4-30.5]；男性平均体积为 1399±425 mm，女性为 1011±242 mm）。此外，即使在调整总斑块体积后，男性也更有可能出现 IPH（优势比[OR]=2.8 [95%置信区间，1.3-6.3]；男性中 IPH 的比例为 49%，女性中为 16%）和 LRNC（OR=2.4 [95%置信区间，1.2-4.7]；男性中 LRNC 的比例为 73%，女性中为 41%）。我们没有发现斑块体积校正后的 IPH、LRNC 和钙化体积在性别之间存在差异。就斑块特征的共存而言，我们发现男性更常出现钙化、LRNC 和 IPH 共存的斑块（OR=2.7 [95%置信区间，1.2-7.0]）、LRNC 和 IPH 共存的薄或破裂纤维帽/溃疡斑块（OR=2.4 [95%置信区间，1.1-5.9]），以及所有斑块特征共存的斑块（OR=3.0 [95%置信区间，1.2-8.6]）。
在有轻度至中度颈动脉狭窄的症状性患者中，男性比女性更有可能出现伴有 IPH 和 LRNC 的高危颈动脉斑块，而不论总斑块负担如何。男性还更常出现具有多种易损斑块成分的斑块，这可能构成更高的卒中风险。
