Mingming Lu, Peng Peng, Lichen Zhang, Shaohua Liu, Fei Yuan, Hongtao Zhang, Shitong Liu, Yao He, Xihai Zhao, Jianming Cai
Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China.
Front Neurol. 2022 Jul 15;13:815150. doi: 10.3389/fneur.2022.815150. eCollection 2022.
This study aimed to investigate the arterial disease risk factors for the progression of intraplaque hemorrhage (IPH) in patients with carotid atherosclerosis using serial high-resolution magnetic resonance (MR) imaging.
Consecutive symptomatic patients who had MRI evidence of intraplaque hemorrhage present in the ipsilateral carotid artery with respect to the side of the brain affected by stroke or TIA were recruited in the study. All the patients underwent follow-up MR imaging at least 6 months after baseline. The annual change in IPH and other carotid plaque morphology was calculated, and a tertile method was used to classify the plaques as progressed or not with respect to IPH volume using the software CASCADE. Logistic regression and receiver operating characteristic (ROC) curve were conducted to evaluate the risk factors for the progression of IPH.
A total of thirty-four symptomatic patients (mean age: 67.1 years, standard deviation [SD]: 9.8 years, 27 men) were eligible for the final analysis, and contralateral plaques containing IPH were seen in 11 of these patients (making 45 plaques with IPH in total). During mean 16.6-month (SD: 11.0 months) follow-up, the overall annual change in IPH volume in 45 plaques with IPH was mean -10.9 mm (SD: 49.1 mm). Carotid plaques were significantly more likely to be classified in progressed IPH group if the patient was taking antiplatelet agent at baseline (OR: 9.76; 95%CI: 1.05 to 90.56; = 0.045), had a baseline history of current or past smoking (OR: 9.28; 95%CI: 1.26 to 68.31; = 0.029), or had a larger baseline carotid plaque-containing vessel wall volume (OR: 1.36 per 10 mm; 95%CI: 1.02 to 1.81; = 0.032) after adjustments for confounding factors. ROC analysis indicated that the combination of these three risk factors in the final model produced good discriminatory value for the progressed IPH group (area under the curve: 0.887).
Taking an antiplatelet agent at baseline, a baseline history of current or past smoking and larger baseline carotid plaque-containing vessel wall volume were independently predictive of plaques being in the progressed IPH group. Our findings indicate that awareness and management of such risk factors may reduce the risk of intraplaque hemorrhage progression.
本研究旨在利用系列高分辨率磁共振成像，调查颈动脉粥样硬化患者斑块内出血（IPH）进展的动脉疾病危险因素。
本研究招募了有症状的连续患者，这些患者同侧颈动脉存在斑块内出血的MRI证据，且出血部位与受中风或短暂性脑缺血发作（TIA）影响的脑区同侧。所有患者在基线检查后至少6个月接受随访磁共振成像检查。计算IPH和其他颈动脉斑块形态的年度变化，并使用软件CASCADE通过三分位数法根据IPH体积将斑块分类为进展或未进展。进行逻辑回归和受试者工作特征（ROC）曲线分析以评估IPH进展的危险因素。
共有34例有症状患者（平均年龄：67.1岁，标准差[SD]：9.8岁，男性27例）符合最终分析条件，其中11例患者对侧斑块存在IPH（总共45个含IPH的斑块）。在平均16.6个月（SD：11.0个月）的随访期间，45个含IPH的斑块中IPH体积的总体年度变化平均为-10.9 mm（SD：49.1 mm）。在校正混杂因素后，如果患者在基线时服用抗血小板药物（比值比：9.76；95%置信区间：1.05至90.56；P = 0.045）、有当前或既往吸烟的基线病史（比值比：9.28；95%置信区间：1.26至68.31；P = 0.029）或基线时含颈动脉斑块的血管壁体积较大（每10 mm比值比：1.36；95%置信区间：1.02至1.81；P = 0.032），颈动脉斑块更有可能被分类为IPH进展组。ROC分析表明，最终模型中这三个危险因素的组合对IPH进展组具有良好的鉴别价值（曲线下面积：0.887）。
基线时服用抗血小板药物、当前或既往吸烟的基线病史以及较大的基线含颈动脉斑块的血管壁体积可独立预测斑块属于IPH进展组。我们的研究结果表明，识别和管理这些危险因素可能会降低斑块内出血进展的风险。
