Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
Neuroradiology. 2024 Jan;66(1):109-116. doi: 10.1007/s00234-023-03244-4. Epub 2023 Nov 13.
The identification of plaque features in the middle cerebral artery (MCA) may help minimize periprocedural complications and select patients suitable for percutaneous transluminal angioplasty and stenting (PTAS). However, relevant research is lacking.
We retrospectively included patients with symptomatic MCA stenosis who received PTAS. All patients underwent intracranial vessel wall MRI (VWMRI) before surgery. Periprocedural complications (PC) included ischemic and hemorrhagic stroke within 30 days. Stenosis location, MCA shape, plaque eccentricity and distribution, plaque thickness and length, and enhancement ratio were compared between patients with and without PC.
Sixty-six patients were included in the study, of which 12.1% (8/66) had PC. Of the eight patients with PC, seven (87.5%) had superior wall plaques. In the non-PC group (n = 58), nine (17%) patients had superior wall plaques. Compared with patients without PC, those with PC had more frequent superior wall plaques (17% vs 87.5%, p < 0.001) and s-shaped MCAs (19% vs 50%, p = 0.071), different stenosis locations (p = 0.012), thicker plaques (1.58 [1.35, 2.00] vs 1.98 [1.73, 2.43], p = 0.038), and less frequent inferior wall plaques (79.2% vs 12.5%, p < 0.001). Multivariate analysis showed that only the presence of superior wall plaques (OR = 41.54 [2.31, 747.54]) was independently associated with PC.
MCA plaque features were highly correlated with PC in patients with symptomatic MCA stenosis who underwent PTAS.
识别大脑中动脉（MCA）中的斑块特征可能有助于最大限度地减少围手术期并发症，并选择适合经皮腔内血管成形术和支架置入术（PTAS）的患者。然而，相关研究较少。
我们回顾性纳入了接受 PTAS 的有症状 MCA 狭窄患者。所有患者均在术前接受颅内血管壁 MRI（VW MRI）检查。围手术期并发症（PC）包括 30 天内的缺血性和出血性卒中。比较了有 PC 和无 PC 患者的狭窄部位、MCA 形态、斑块偏心度和分布、斑块厚度和长度以及强化率。
本研究共纳入 66 例患者，其中 12.1%（8/66）发生 PC。在 8 例 PC 患者中，7 例（87.5%）为上壁斑块。在无 PC 组（n=58）中，有 9 例（17%）患者为上壁斑块。与无 PC 患者相比，有 PC 的患者上壁斑块更常见（17%比 87.5%，p<0.001），MCA 呈 S 形更多见（19%比 50%，p=0.071），狭窄部位不同（p=0.012），斑块更厚（1.58 [1.35, 2.00] 比 1.98 [1.73, 2.43]，p=0.038），下壁斑块更少见（79.2%比 12.5%，p<0.001）。多变量分析显示，只有上壁斑块的存在（OR=41.54 [2.31, 747.54]）与 PC 独立相关。
在接受 PTAS 的有症状 MCA 狭窄患者中，MCA 斑块特征与 PC 高度相关。
