Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
Cerebrovasc Dis. 2024;53(5):598-606. doi: 10.1159/000535274. Epub 2023 Nov 20.
Carotid atherosclerotic intraplaque hemorrhage (IPH) predicts stroke. Patients with a history of stroke are treated with antiplatelet agents to prevent secondary cardiovascular events. A positive association between previous antiplatelet use and IPH was reported in a cross-sectional analysis. We investigated the changes in IPH over 2 years in patients who recently started versus those with continued antiplatelet use.
In the Plaque at Risk (PARISK) study, symptomatic patients with <70% ipsilateral carotid stenosis underwent carotid plaque magnetic resonance imaging (MRI) at the baseline and after 2 years to determine IPH presence and volume. Participants were categorized into new users (starting antiplatelet therapy following the index event) and continued users (previous use of antiplatelet therapy before the index event). The association between previous antiplatelet therapy and the presence of IPH at baseline MRI was investigated using multivariable logistic regression analysis. The IPH volume change over a period of 2 years, defined as the difference in volume between follow-up and baseline, was investigated in each group with a Wilcoxon signed-rank test. The IPH volume change was categorized as progression, regression, or no change. Using multivariable logistic regression, we investigated the association between new antiplatelet use and (1) newly developed ipsilateral or contralateral IPH and (2) IPH volume progression.
A total of 108 patients underwent carotid MRI at the baseline and follow-up. At the baseline, previous antiplatelet therapy was associated with any IPH (OR = 5.6, 95% CI: 1.3-23.1; p = 0.02). Ipsilateral IPH volume did not change significantly during the 2 years in patients who continued receiving antiplatelet agents (86.4 mm3 [18.2-235.9] vs. 59.3 mm3 [11.4-260.3]; p = 0.6) nor in the new antiplatelet users (n = 31) (61.5 mm3 [0.0-166.9] vs. 27.7 mm3 [9.5-106.4]; p = 0.4). Similar results of a nonsignificant change in contralateral IPH volume during those 2 years were observed in both groups (p > 0.05). No significant associations were found between new antiplatelet use and newly developed IPH at 2 years (odds ratio [OR] = 1.0, 95% CI: 0.1-7.4) or the progression of IPH (ipsilateral: OR = 2.4, 95% CI: 0.3-19.1; contralateral: OR = 0.3, 95% CI: 0.01-8.5).
Although the baseline association between IPH and previous antiplatelet therapy was confirmed in this larger cohort, the new onset of antiplatelet therapy after transient ischemic attack/stroke was not associated with the newly developed IPH or progression of IPH volume over the subsequent 2 years.
颈动脉粥样硬化斑块内出血（IPH）可预测中风。有中风病史的患者使用抗血小板药物预防心血管事件的二次发生。横断面分析显示，既往使用抗血小板药物与 IPH 呈正相关。我们研究了近期开始使用抗血小板药物与持续使用抗血小板药物的患者在 2 年内 IPH 的变化情况。
在斑块风险（PARISK）研究中，<70%同侧颈动脉狭窄的有症状患者在基线和 2 年后行颈动脉斑块磁共振成像（MRI）检查，以确定 IPH 的存在和体积。将参与者分为新使用者（指数事件后开始抗血小板治疗）和持续使用者（指数事件前使用过抗血小板治疗）。使用多变量逻辑回归分析研究既往抗血小板治疗与基线 MRI 时 IPH 存在之间的关系。使用 Wilcoxon 符号秩检验分别在两组中研究 2 年内 IPH 体积的变化（定义为随访与基线之间的体积差异）。将 IPH 体积变化分为进展、消退或无变化。使用多变量逻辑回归，我们研究了新的抗血小板治疗与（1）同侧或对侧新发生的 IPH 和（2）IPH 体积进展之间的关系。
共有 108 例患者在基线和随访时接受了颈动脉 MRI 检查。在基线时，既往抗血小板治疗与任何 IPH 相关（OR = 5.6，95%CI：1.3-23.1；p = 0.02）。继续接受抗血小板药物治疗的患者在 2 年内 IPH 体积无明显变化（86.4 mm3 [18.2-235.9] 与 59.3 mm3 [11.4-260.3]；p = 0.6），新使用抗血小板药物的患者（n = 31）也无明显变化（61.5 mm3 [0.0-166.9] 与 27.7 mm3 [9.5-106.4]；p = 0.4）。在这两组患者中，在这 2 年内，对侧 IPH 体积的变化也无显著变化（p > 0.05）。新的抗血小板治疗与 2 年内新发生的 IPH 或 IPH 体积进展无显著相关性（同侧：OR = 1.0，95%CI：0.1-7.4；对侧：OR = 0.3，95%CI：0.01-8.5）。
尽管在这个更大的队列中证实了 IPH 与既往抗血小板治疗之间的基线关联，但短暂性脑缺血发作/中风后新开始的抗血小板治疗与随后 2 年内新发生的 IPH 或 IPH 体积进展无关。
