Li Na, Zhou Fubo, Chen Songwei, Cui Liuping, Chen Hongxiu, Xing Yingqi
Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
J Clin Neurosci. 2025 Jun;136:111280. doi: 10.1016/j.jocn.2025.111280. Epub 2025 Apr 29.
Atherosclerotic stenosis of the carotid artery is a major cause of ischemic stroke. We aimed to identify extracranial and intracranial features associated with cerebral ischemic events in patients with severe carotid artery stenosis using carotid ultrasonography and transcranial Doppler.
We retrospectively enrolled 130 patients with severe carotid artery stenosis and 45 age- and sex-matched healthy controls. Extracranial carotid artery parameters included carotid plaque morphology, echogenicity, and the gray-scale median (GSM). Intracranial features, mainly dynamic cerebral autoregulation (dCA), were assessed using transfer function analysis. Correlations between extracranial and intracranial parameters and cerebral ischemic events were analyzed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were compared.
Sixty-six patients (50.8 %) experienced cerebral ischemic events upon admission. Extracranial features (proportion of ulcerated plaques and echogenicity classification) significantly differed between the asymptomatic and symptomatic groups. The mean GSM of carotid plaques (48.9 ± 17.3 vs. 62.1 ± 18.3, P < 0.001) and intracranial parameters were significantly lower in the symptomatic group. Plaque ulceration, hypoechoic plaques, and impaired dCA [lower ipsilateral phase at very-low frequency (VLF)] were independently associated with cerebral ischemic events in patients with severe carotid artery stenosis. The combined GSM and ipsilateral phase at VLF had the highest area under the ROC curve (0.784).
Combined extracranial and intracranial assessments may help predict cerebral ischemic events in patients with severe carotid artery stenosis. Ultrasound-based carotid plaque characteristics, combined with dynamic cerebral autoregulation, could be imaging biomarkers of cerebral ischemic events in patients with severe carotid artery stenosis.
颈动脉粥样硬化狭窄是缺血性卒中的主要原因。我们旨在使用颈动脉超声和经颅多普勒来识别重度颈动脉狭窄患者中与脑缺血事件相关的颅外和颅内特征。
我们回顾性纳入了130例重度颈动脉狭窄患者和45例年龄及性别匹配的健康对照者。颅外颈动脉参数包括颈动脉斑块形态、回声性和灰阶中位数（GSM）。颅内特征主要是动态脑自动调节（dCA），使用传递函数分析进行评估。使用单因素和多因素逻辑回归分析来分析颅外和颅内参数与脑缺血事件之间的相关性。比较受试者工作特征（ROC）曲线。
66例患者（50.8%）入院时发生脑缺血事件。无症状组和有症状组的颅外特征（溃疡斑块比例和回声性分类）有显著差异。有症状组颈动脉斑块的平均GSM（48.9±17.3对62.1±18.3，P<0.001）和颅内参数显著更低。斑块溃疡、低回声斑块和dCA受损[极低频率（VLF）时同侧相位更低]与重度颈动脉狭窄患者的脑缺血事件独立相关。GSM与VLF时同侧相位的组合在ROC曲线下面积最大（0.784）。
颅外和颅内联合评估可能有助于预测重度颈动脉狭窄患者的脑缺血事件。基于超声的颈动脉斑块特征，结合动态脑自动调节，可能是重度颈动脉狭窄患者脑缺血事件的影像学生物标志物。
