Tziotziou Aikaterini, Fontana Federica, Korteland Suze-Anne, Nies Kelly, Nederkoorn Paul, de Jong Pim A, Kooi M Eline, van der Lugt Aad, van der Steen Anton F W, Wentzel Jolanda J, Bos Daniel, Akyildiz Ali C
Department of Cardiology, Biomedical Engineering, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Cerebrovasc Dis. 2025 May 2:1-11. doi: 10.1159/000546164.
Ischemic stroke incidence varies significantly with respect to sex and cardiovascular risk factors (CVRFs), a relationship that it is not well understood. Calcification in carotid atherosclerosis is known to impact plaque stability, potentially linked to ischemic stroke. The objective was to assess the in-depth calcification morphometrics within extracranial carotid atherosclerosis, their temporal changes, and associations with sex and CVRFs.
Carotid arteries (n = 144) with confirmed atherosclerosis and mild-to-moderate stenosis from 72 symptomatic patients (Plaque-At-Risk study) with recent ischemic event due to ischemia in the territory of a carotid artery were imaged using multidetector computed tomography angiography (MDCTA) at baseline and after 2 years. The lumen, vessel wall, and calcifications were segmented semiautomatically, and the carotid geometries were 3D reconstructed. A comprehensive morphometric assessment of carotid calcifications was performed on the baseline and follow-up scans. We investigated distributions of these metrics and their associations with sex and CVRFs using generalized linear mixed models.
Our findings suggest that women have larger (4.5 mm2 [95% CI: 3.2-6.2] vs. 3.2 mm2 [95% CI: 2.4-4.2]) calcifications, located closer to the lumen (0.6 mm [95% CI: 0.4-0.8] vs. 0.9 mm [95% CI: 0.7-1.2]) in contrast to men at baseline and follow-up, adjusted for baseline measurements. At the baseline, nonsmokers had larger (5.3 mm2 [95% CI: 3.7-7.5] vs. 3.2 mm2 [95% CI: 2.3-4.4]) and longer (5.7 mm [95% CI: 4.1-7.3] vs. 2.4 mm [95% CI: 1.6-3.6]) calcifications than the current smokers. Diabetic patients had thicker (1.1 mm [95% CI: 0.8-1.3] vs. 0.8 mm [95% CI: 0.7-0.9]) carotid calcifications at baseline.
Our in-depth analyses exposed several geometric features of carotid calcifications associated with sex and CVRFs and provided further insight into the pathophysiology of carotid atherosclerosis.
缺血性中风的发病率在性别和心血管危险因素（CVRF）方面存在显著差异，这种关系尚未得到充分理解。已知颈动脉粥样硬化中的钙化会影响斑块稳定性，这可能与缺血性中风有关。目的是评估颅外颈动脉粥样硬化内钙化的深度形态计量学、其时间变化以及与性别和CVRF的关联。
对72例有症状患者（斑块风险研究）的144条已确诊动脉粥样硬化且有轻度至中度狭窄的颈动脉进行成像，这些患者近期因颈动脉供血区域缺血发生缺血性事件，在基线时和2年后使用多排螺旋CT血管造影（MDCTA）进行检查。对管腔、血管壁和钙化进行半自动分割，并对颈动脉几何形状进行三维重建。在基线和随访扫描时对颈动脉钙化进行全面的形态计量学评估。我们使用广义线性混合模型研究这些指标的分布及其与性别和CVRF的关联。
我们的研究结果表明，在基线和随访时，经基线测量调整后，与男性相比，女性的钙化面积更大（4.5平方毫米[9５%置信区间：3.2 - 6.2]对3.2平方毫米[95%置信区间：2.4 - 4.2]），且位置更靠近管腔（分别为0.6毫米[95%置信区间：0.4 - 0.8]对0.9毫米[95%置信区间：0.7 - 1.2]）。在基线时，与当前吸烟者相比，非吸烟者的钙化面积更大（5.3平方毫米[95%置信区间：3.7 - 7.5]对3.2平方毫米[95%置信区间：2.3 - 4.4]）且更长（5.7毫米[95%置信区间：4.1 - 7.3]对2.4毫米[95%置信区间：1.6 - 3.6]）。糖尿病患者在基线时的颈动脉钙化更厚（1.1毫米[95%置信区间：0.8 - 1.3]对0.8毫米[95%置信区间：0.7 - 0.9]）。
我们的深入分析揭示了与性别和CVRF相关的颈动脉钙化的几个几何特征，并为颈动脉粥样硬化的病理生理学提供了进一步的见解。
