Mei Yuexin, Yu Shan, Li Zhuhao, Chen Hongbing, Zhang Jian, Tan Shuangquan, Zeng Jinsheng, Xing Shihui, Chen Xinran
Neurology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China.
Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China.
J Neurointerv Surg. 2024 Jan 31. doi: 10.1136/jnis-2023-021295.
Primary balloon angioplasty (PBA) is an alternative treatment approach for intracranial atherosclerotic stenosis (ICAS); however, its efficacy may be compromised by arterial dissection or early elastic recoil after balloon dilation. This study aimed to explore the association between plaque characteristics on high-resolution magnetic resonance vessel wall imaging (HR-VWI) and failure of PBA for ICAS.
We conducted a retrospective analysis of 113 patients with ICAS who underwent HR-VWI before endovascular treatment. Based on the presence of arterial dissection or early elastic recoil post-balloon dilation, patients were classified into the failed PBA (FPBA) group or the successful PBA (SPBA) group. Clinical and baseline HR-VWI characteristics were compared between the two groups. Multivariable analysis was used to investigate plaque features associated with the failure of PBA.
The FPBA and SPBA groups comprised 74 and 39 patients, respectively. Plaque eccentricity (83.78% vs 46.15%, P<0.001), negative remodeling (90.54% vs 48.72%, P<0.001), remodeling index (median 0.73 vs 0.90, P=0.001), and intraplaque hemorrhage (31.08% vs 5.13%, P=0.002) differed significantly between the FPBA and SPBA groups. Multivariable analysis indicated that higher frequency of plaque eccentricity (OR 14.03, 95% CI 3.42 to 57.62, P<0.001) and negative remodeling (OR 6.11, 95% CI 1.22 to 30.71, P=0.028) were independently associated with failure of PBA.
Our findings showed that failure of PBA was associated with plaque eccentricity and negative remodeling. Analysis of plaque characteristics on baseline HR-VWI holds potential value for identifying arterial dissection or early elastic recoil after angioplasty in patients with ICAS.
原发性球囊血管成形术（PBA）是治疗颅内动脉粥样硬化性狭窄（ICAS）的一种替代方法；然而，其疗效可能会因球囊扩张后的动脉夹层或早期弹性回缩而受到影响。本研究旨在探讨高分辨率磁共振血管壁成像（HR-VWI）上的斑块特征与ICAS患者PBA失败之间的关联。
我们对113例在血管内治疗前行HR-VWI检查的ICAS患者进行了回顾性分析。根据球囊扩张后是否存在动脉夹层或早期弹性回缩，将患者分为PBA失败（FPBA）组或PBA成功（SPBA）组。比较两组的临床和基线HR-VWI特征。采用多变量分析来研究与PBA失败相关的斑块特征。
FPBA组和SPBA组分别有74例和39例患者。FPBA组和SPBA组之间的斑块偏心性（83.78%对46.15%，P<0.001）、负性重构（90.54%对48.72%，P<0.001）、重构指数（中位数0.73对0.90，P=0.001）和斑块内出血（31.08%对5.13%，P=0.002）差异有统计学意义。多变量分析表明，较高频率的斑块偏心性（OR 14.03，95%CI 3.42至57.62，P<0.001）和负性重构（OR 6.11，95%CI 1.22至30.71，P=0.028）与PBA失败独立相关。
我们的研究结果表明，PBA失败与斑块偏心性和负性重构有关。对基线HR-VWI上的斑块特征进行分析，对于识别ICAS患者血管成形术后的动脉夹层或早期弹性回缩具有潜在价值。
