Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100160, China.
Guang'anmen Hospital, Chinese Academy of traditional Chinese Medicine, Beijing, China.
BMC Neurol. 2023 Jan 12;23(1):13. doi: 10.1186/s12883-023-03052-6.
Carotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.
This study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2-6/3-6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.
SMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19-111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2-6, and a total of 10 (15.4%) patients had a mRS of 3-6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2-6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3-6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2-6 was 3.06 (95% CI 1.05-12.59, P = 0.041) and 0.51 (95% CI 0.31-0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3-6 was 6.11 (95% CI 1.19-31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59-0.87), 0.76 (95% CI 0.64-0.89) and 0.85 (95% CI 0.76-0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63-0.95).
Intraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.
颈动脉易损斑块是中风发生和复发的一个重要危险因素。然而，颈动脉易损斑块的风险参数（斑块大小、回声、斑块内新生血管形成和斑块硬度）与缺血性卒中和 TIA 后神经功能结局之间的关系尚不清楚。本研究旨在探讨基于多模态超声的颈动脉斑块风险生物标志物预测颈动脉粥样硬化性缺血性卒中和 TIA 后近期不良短期功能结局的价值。
这是一项单中心、前瞻性、连续、队列研究，观察缺血性卒中和 TIA 后 90 天患者不良功能结局（mRS 2-6/3-6）的发生情况，本研究中的暴露因素为颈动脉斑块超声风险生物标志物，风险因素为性别、年龄、病史和用药史。纳入的患者为同侧颈内动脉狭窄≥50%的缺血性卒中和 TIA（mRS≤3）患者。所有患者均在基线时进行多模态超声检查，包括常规超声、超微血流成像（SMI）和剪切波弹性成像（SWE）。连续变量按四分位间距分为四组，纳入单因素和多因素分析。完成基线超声检查后，所有患者在超声检查后 90 天进行随访，并记录患者改良神经功能评分（mRSs）。多因素 Cox 回归和 ROC 曲线用于评估预测不良神经功能的风险因素和预测能力。
SMI 显示 20 例（30.8%）患者颈动脉斑块内广泛新生血管形成，45 例（69.2%）患者颈动脉斑块内局限新生血管形成。SWE 成像显示颈动脉斑块平均硬度为 51.49±18.34kPa（23.19-111.39kPa）。平均随访 90±14 天后，共有 21 例（32.3%）患者 mRS 为 2-6，共有 10 例（15.4%）患者 mRS 为 3-6。Cox 回归分析显示，斑块内新生血管形成水平和斑块硬度是 mRS 为 2-6 的独立危险因素，斑块内新生血管形成水平是 mRS 为 3-6 的独立危险因素。在纠正混杂因素后，斑块内新生血管形成水平和斑块硬度预测 mRS 2-6 的 HR 分别为 3.06（95%CI 1.05-12.59，P=0.041）和 0.51（95%CI 0.31-0.83，P=0.007）；斑块内新生血管形成水平预测 mRS 3-6 的 HR 为 6.11（95%CI 1.19-31.45，P=0.031）。对于 ROC 曲线分析，斑块内新生血管形成水平、斑块硬度和联合应用预测 90 天神经功能结局的 mRS 范围为 2-6，AUC 分别为 0.73（95%CI 0.59-0.87）、0.76（95%CI 0.64-0.89）和 0.85（95%CI 0.76-0.95）。斑块内新生血管形成水平预测 90 天神经功能结局的 mRS 范围为 3-6，AUC 为 0.79（95%CI 0.63-0.95）。
颈动脉粥样硬化性缺血性卒中和 TIA 患者近期，斑块内新生血管形成水平和斑块硬度可能与不良短期功能结局风险增加相关。多个参数的联合应用在预测缺血性卒中和 TIA 后近期不良短期功能结局方面具有一定的预测价值。
