Ferreira Joana, Longatto-Filho Adhemar, Dionísio Ana, Correia-Neves Margarida, Cunha Pedro, Mansilha Armando
Vascular Surgery Department, Physiology and Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal.
Academic Centre of Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal.
J Cardiovasc Dev Dis. 2024 Feb 11;11(2):58. doi: 10.3390/jcdd11020058.
Vulnerable carotid plaques are responsible for 20% of the ischemic strokes. The identification of these asymptomatic carotid plaques that will become symptomatic is essential but remains unclear. Our main goal was to investigate whether the amount of the peri-carotid adipose tissue, estimated by the extra-media thickness (EMT), is associated with the atherosclerotic characteristics at the carotid bifurcation in patients with PAD. An observational, prospective, single-center, longitudinal study was conducted. Overall, 177 patients were subjected to carotid Doppler ultrasound at the study admission. The following data were collected: EMT, intima-media thickness (IMT), the presence of carotid plaques, the area of the highest plaque, the presence of "acute culprit" carotid stenosis, and the grade of internal carotid stenosis. "Acute culprit" carotid stenosis was defined as a significant atherosclerotic plaque that leads to a neurologic event within 15 days. From each carotid bifurcation, a right and a left EMT were determined. We analyzed both the mean EMTs (calculated as the mean between the right and the left EMT) and the EMT ipsilateral to the carotid bifurcation. The presence of carotid plaques was associated with a higher mean EMT [Median = 1.14; IQR = 0.66 versus Median = 0.97; IQR = 0.40; = 0.001]. A positive correlation was found between the mean EMT and IMT (right: ρ = 0.20; = 0.010; left: ρ = 0.21; = 0.007) and between the mean EMT and the area of the largest carotid plaque (right: ρ = 0.17; = 0.036; left: ρ = 0.22; = 0.004). Left carotid stenosis ≥ 70% was associated with higher ipsilateral EMT [Median = 1.56; IQR = 0.70 versus Median = 0.94; IQR = 0.42; = 0.009]. Patients with "acute culprit" carotid stenosis had a higher ipsilateral EMT [left ipsilateral EMT: Median = 1.46; IQR = 0.63; "non-acute": Median = 0.94; IQR = 0.43; = 0.009; right ipsilateral EMT: Median = 2.25; IQR = 0.62; "non-acute": Median = 1.00; IQR = 0.51; = 0.015]. This difference was not found in the contra-lateral EMT. Six months after the neurologic event, EMT ipsilateral to an "acute culprit" carotid stenosis decreased ( = 0.036). The amount of peri-carotid adipose tissue, estimated with EMT, was associated with atherosclerosis at the carotid arteries. The mean EMT was associated with the features of chronic atherosclerosis lesions: the presence of carotid plaques, IMT, and the area of the highest plaque. Ipsilateral EMT was linked with "acute culprit" atherosclerotic plaque.
易损性颈动脉斑块导致了20%的缺血性中风。识别这些将会出现症状的无症状颈动脉斑块至关重要，但目前仍不清楚。我们的主要目标是研究通过中膜外厚度（EMT）估算的颈动脉周围脂肪组织量是否与外周动脉疾病（PAD）患者颈动脉分叉处的动脉粥样硬化特征相关。我们进行了一项观察性、前瞻性、单中心纵向研究。总体而言，177例患者在研究入组时接受了颈动脉多普勒超声检查。收集了以下数据：EMT、内膜中层厚度（IMT）、颈动脉斑块的存在情况、最大斑块面积、“急性责任”颈动脉狭窄的存在情况以及颈内动脉狭窄程度。“急性责任”颈动脉狭窄定义为在15天内导致神经事件的显著动脉粥样硬化斑块。从每个颈动脉分叉处分别测定右侧和左侧的EMT。我们分析了平均EMT（计算为右侧和左侧EMT的平均值）以及与颈动脉分叉同侧的EMT。颈动脉斑块的存在与更高的平均EMT相关[中位数 = 1.14；四分位数间距 = 0.66，而中位数 = 0.97；四分位数间距 = 0.40；P = 0.001]。在平均EMT与IMT之间发现了正相关（右侧：ρ = 0.20；P = 0.010；左侧：ρ = 0.21；P = 0.007），并且在平均EMT与最大颈动脉斑块面积之间也发现了正相关（右侧：ρ = 0.17；P = 0.036；左侧：ρ = 0.22；P = 0.004）。左侧颈动脉狭窄≥70%与同侧更高的EMT相关[中位数 = 1.56；四分位数间距 = 0.70，而中位数 = 0.94；四分位数间距 = 0.42；P = 0.009]。患有“急性责任”颈动脉狭窄的患者同侧EMT更高[左侧同侧EMT：中位数 = 1.46；四分位数间距 = 0.63；“非急性”：中位数 = 0.94；四分位数间距 = 0.43；P = 0.009；右侧同侧EMT：中位数 = 2.25；四分位数间距 = 0.62；“非急性”：中位数 = 1.00；四分位数间距 = 0.51；P = 0.015]。在对侧EMT中未发现这种差异。神经事件发生6个月后，与“急性责任”颈动脉狭窄同侧的EMT降低（P = 0.036）。通过EMT估算的颈动脉周围脂肪组织量与颈动脉处的动脉粥样硬化相关。平均EMT与慢性动脉粥样硬化病变的特征相关：颈动脉斑块的存在、IMT以及最大斑块面积。同侧EMT与“急性责任”动脉粥样硬化斑块相关。
