Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Korean J Radiol. 2023 Apr;24(4):338-348. doi: 10.3348/kjr.2022.0977. Epub 2023 Feb 16.
Patients with a history of ischemic stroke are at risk for a second ischemic stroke. This study aimed to investigate the relationship between carotid plaque enhancement on perfluorobutane microbubble contrast-enhanced ultrasonography (CEUS) and future recurrent stroke, and to determine whether plaque enhancement can contribute to risk assessment for recurrent stroke compared with the Essen Stroke Risk Score (ESRS).
This prospective study screened 151 patients with recent ischemic stroke and carotid atherosclerotic plaques at our hospital between August 2020 and December 2020. A total of 149 eligible patients underwent carotid CEUS, and 130 patients who were followed up for 15-27 months or until stroke recurrence were analyzed. Plaque enhancement on CEUS was investigated as a possible risk factor for stroke recurrence and as a possible adjunct to ESRS.
During follow-up, 25 patients (19.2%) experienced recurrent stroke. Patients with plaque enhancement on CEUS had an increased risk of stroke recurrence events (22/73, 30.1%) compared to those without plaque enhancement (3/57, 5.3%), with an adjusted hazard ratio (HR) of 38.264 (95% confidence interval [CI]:14.975-97.767; < 0.001) according to a multivariable Cox proportional hazards model analysis, indicating that the presence of carotid plaque enhancement was a significant independent predictor of recurrent stroke. When plaque enhancement was added to the ESRS, the HR for stroke recurrence in the high-risk group compared to that in the low-risk group (2.188; 95% CI, 0.025-3.388) was greater than that of the ESRS alone (1.706; 95% CI, 0.810-9.014). A net of 32.0% of the recurrence group was reclassified upward appropriately by the addition of plaque enhancement to the ESRS.
Carotid plaque enhancement was a significant and independent predictor of stroke recurrence in patients with ischemic stroke. Furthermore, the addition of plaque enhancement improved the risk stratification capability of the ESRS.
有缺血性卒中病史的患者存在再次发生缺血性卒中的风险。本研究旨在探讨经氟丙烷微泡超声造影（CEUS）检查颈动脉斑块增强与未来复发性卒中之间的关系，并确定与 Essen 卒中风险评分（ESRS）相比，斑块增强是否有助于复发性卒中的风险评估。
本前瞻性研究于 2020 年 8 月至 2020 年 12 月在我院筛选了 151 例近期发生缺血性卒中且伴有颈动脉粥样硬化斑块的患者。共有 149 例符合条件的患者接受了颈动脉 CEUS 检查，对其中 130 例随访 15-27 个月或直至卒中复发的患者进行了分析。研究将 CEUS 上的斑块增强作为卒中复发的可能危险因素，并作为 ESRS 的辅助手段进行探讨。
在随访期间，25 例患者（19.2%）发生了复发性卒中。CEUS 上有斑块增强的患者发生卒中复发事件的风险增加（22/73，30.1%），而无斑块增强的患者为 3/57（5.3%），多变量 Cox 比例风险模型分析显示，校正后 HR 为 38.264（95%CI：14.975-97.767；<0.001），表明颈动脉斑块增强是复发性卒中的显著独立预测因素。当将斑块增强加入 ESRS 时，与低危组相比，高危组的卒中复发 HR（2.188；95%CI，0.025-3.388）大于 ESRS 单独时的 HR（1.706；95%CI，0.810-9.014）。通过将斑块增强加入 ESRS，可使 32.0%的复发性卒中患者的风险分层得到适当的重新分类。
颈动脉斑块增强是缺血性卒中患者卒中复发的显著且独立的预测因素。此外，斑块增强的加入提高了 ESRS 的风险分层能力。
