Guo Danling, Lv Sangying, Wu Guanzuan, Li Haifeng, Wei Bo, Yang Jianfeng
Department of Radiology, Shaoxing People's Hospital, Shaoxing, China.
Department of Neurology, Shaoxing People's Hospital, Shaoxing, China.
Front Cardiovasc Med. 2022 Aug 23;9:971500. doi: 10.3389/fcvm.2022.971500. eCollection 2022.
Embolic stroke of undetermined source (ESUS) is a subset of cryptogenic stroke constituting a large proportion of acute ischemic strokes. This study aimed to assess the features of non-stenotic carotid plaque (<50%) on computed tomographic angiography (CTA) and to evaluate the association between non-stenotic carotid plaque and ESUS.
From January 1 to December 31, 2019, a total of 60 consecutive patients with primary unilateral ESUS and <50% carotid artery stenosis, as determined using screening ultrasonography, were hospitalized in the Department of Neurology of our hospital. All enrolled patients underwent CTA to determine the composition and morphological features of non-stenotic carotid plaques using consecutive sections in both carotid arteries. The features of these plaques with and without ipsilateral stroke in patients with ESUS were compared.
Sixty ESUS images were included in the study, with 85 plaques. Forty-five (52.9%) of these plaques were ipsilateral and 40 (47.1%) were contralateral to the stroke. Compared to that of the contralateral plaque group, the maximum carotid plaque thickness and plaque length of the ipsilateral group were greater (2.1 mm vs. 1.5 mm, = 0.03; 20.8 mm vs. 12.1 mm, = 0.02); however, there were no significant differences in the degree of luminal stenosis, presence of soft plaque and calcified plaque, and the number of ulcers on the plaque surface between the two groups. Similarly, the number of plaques with thickness >3 mm in the ipsilateral group was greater than in the contralateral group (30 vs. 13, = 0.01). A lipid core was more common in individuals with ipsilateral strokes than in those with contralateral strokes (19 vs. 7, = 0.02). Regression analysis showed that plaque lipid core area was an independent risk factor for ESUS (odds ratio, 1.92; 95% confidence interval, 1.22-3.04; = 0.03).
Non-stenotic carotid plaques could be an etiology of acute ischemic strokes classified as ESUS. The presence of a lipid core was a risk factor in individuals with non-stenotic carotid plaques.
不明来源栓塞性卒中（ESUS）是隐源性卒中的一个子集，在急性缺血性卒中中占很大比例。本研究旨在评估计算机断层血管造影（CTA）上非狭窄性颈动脉斑块（<50%）的特征，并评估非狭窄性颈动脉斑块与ESUS之间的关联。
2019年1月1日至12月31日，共有60例经筛查超声检查确定为原发性单侧ESUS且颈动脉狭窄<50%的连续患者入住我院神经内科。所有纳入研究的患者均接受CTA检查，通过双侧颈动脉的连续切片确定非狭窄性颈动脉斑块的成分和形态特征。比较ESUS患者中这些有同侧卒中与无同侧卒中的斑块特征。
本研究纳入了60例ESUS图像，共有85个斑块。其中45个（52.9%）斑块位于同侧，40个（47.1%）位于对侧。与对侧斑块组相比，同侧组的最大颈动脉斑块厚度和斑块长度更大（2.1mm对1.5mm，P = 0.03；20.8mm对12.1mm，P = 0.02）；然而，两组之间在管腔狭窄程度、软斑块和钙化斑块的存在情况以及斑块表面溃疡数量方面无显著差异。同样，同侧组中厚度>3mm的斑块数量多于对侧组（30对13，P = 0.01）。与对侧卒中患者相比，同侧卒中患者中脂质核心更常见（19对7，P = 0.02）。回归分析表明，斑块脂质核心面积是ESUS的独立危险因素（比值比，1.92；95%置信区间，1.22 - 3.04；P = 0.03）。
非狭窄性颈动脉斑块可能是归类为ESUS的急性缺血性卒中的病因。脂质核心的存在是有非狭窄性颈动脉斑块患者的一个危险因素。
