Sun Yu-Meng, Xu Hai-Yang, Wang Shuo, Wang Zhen-Jia, Zhou You, Yu Wei
Department of Radiology, Beijing Anzhen Hospital, Beijing, China.
Department of Vascular Surgery, Beijing Anzhen Hospital, Beijing, China.
Cardiovasc Diagn Ther. 2023 Apr 28;13(2):355-366. doi: 10.21037/cdt-22-543. Epub 2023 Mar 1.
Following carotid artery stenting (CAS), new ipsilateral ischemic lesions (NIILs) in the brain are frequently seen using diffusion-weighted imaging (DWI). This study's goal was to identify the imaging characteristics associated with NIILs after CAS by high-resolution magnetic resonance vessel wall imaging (HR-VWI).
This was a case-control study. 109 patients who received CAS for atherosclerotic carotid stenosis were retrospectively collected and categorized into NIILs positive and NIILs negative groups. Based on the existence or absence of stroke symptoms after CAS, the NIILs positive group was split into two subgroups: the NIILs symptomatic group and the NIILs asymptomatic group. Patients underwent preoperative HR-VWI and brain magnetic resonance imaging (MRI) within 7 days preoperatively and within 3 days postoperatively. Quantitatively assess carotid plaque burden and components using HR-VWI. The baseline and HR-VWI imaging characteristics of all patients were retrospectively analyzed. To ascertain the imaging characteristics connected with NIILs after CAS, logistic regression analysis was carried out.
Among 109 patients, 38 patients (34.9%) developed NIILs after CAS. Six patients (5.5%) developed symptomatic stroke with NIILs. The logistic regression analysis revealed that maximum wall thickness (Max WT) [odds ratio (OR), 1.53; 95% confidence interval (CI): 1.20-1.96; P=0.001], the maximum area percentage of lipid-rich necrotic core (LRNC) (OR, 1.05; 95% CI: 1.03-1.07; P<0.001), the volume of LRNC (OR, 1.004; 95% CI: 1.002-1.005; P<0.001), the maximum area percentage of intraplaque hemorrhage (IPH) (OR, 1.17; 95% CI: 1.11-1.24; P<0.001), the volume of IPH (OR, 1.06; 95% CI: 1.03-1.08; P<0.001), and maximum circumference score of calcification in a single slice (OR, 1.66; 95% CI: 1.04-2.63; P=0.03) were linked with NIILs following CAS.
The massive IPH, LRNC, and heavy circumferential calcification were associated with NIILs after CAS. Preoperative quantitative assessment of carotid plaque using HR-VWI may be useful for predicting NIILs following CAS.
在颈动脉支架置入术（CAS）后，使用弥散加权成像（DWI）经常能在脑部发现新的同侧缺血性病变（NIILs）。本研究的目的是通过高分辨率磁共振血管壁成像（HR-VWI）确定与CAS后NIILs相关的影像学特征。
这是一项病例对照研究。回顾性收集109例因动脉粥样硬化性颈动脉狭窄接受CAS的患者，并将其分为NIILs阳性组和NIILs阴性组。根据CAS后是否出现卒中症状，将NIILs阳性组分为两个亚组：NIILs有症状组和NIILs无症状组。患者在术前7天内和术后3天内接受术前HR-VWI和脑部磁共振成像（MRI）检查。使用HR-VWI定量评估颈动脉斑块负荷和成分。对所有患者的基线和HR-VWI影像学特征进行回顾性分析。为确定CAS后与NIILs相关的影像学特征，进行了逻辑回归分析。
109例患者中，38例（34.9%）在CAS后出现NIILs。6例（5.5%）出现伴有NIILs的有症状性卒中。逻辑回归分析显示，最大管壁厚度（Max WT）[比值比（OR），1.53；95%置信区间（CI）：1.20-1.96；P=0.001]、富含脂质坏死核心（LRNC）的最大面积百分比（OR，1.05；95%CI：1.03-1.07；P<0.001）、LRNC体积（OR，1.004；95%CI：1.002-1.005；P<0.001）、斑块内出血（IPH）的最大面积百分比（OR，1.17；95%CI：1.11-1.24；P<0.001）、IPH体积（OR，1.06；95%CI：1.03-1.08；P<0.001）以及单层钙化的最大周长评分（OR，1.66；95%CI：1.04-2.63；P=0.03）与CAS后的NIILs相关。
大量IPH、LRNC和重度圆周钙化与CAS后的NIILs相关。使用HR-VWI对颈动脉斑块进行术前定量评估可能有助于预测CAS后的NIILs。
