Mura Mathilde, Rivoire Emeraude, Dehina-Khenniche Leila, Jazzar Ghina, Schlatter Sophie, Della-Schiava Nellie, Arsicot Matthieu, Fayad Zahi A, Lermusiaux Patrick, Long Anne, Douek Philippe, Chirico Erica N, Thomas Amandine, Pialoux Vincent, Millon Antoine
University Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France.
Vascular and Endovascular Surgery Department, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.
EClinicalMedicine. 2025 Apr 22;83:103158. doi: 10.1016/j.eclinm.2025.103158. eCollection 2025 May.
Management of asymptomatic patients with carotid atherosclerotic plaque is still debated. Intraplaque haemorrhage measured by magnetic resonance imaging is the best indicator of plaque instability and ischaemic risk. A cross-sectional study reported that physical activity was associated with lower prevalence of carotid intraplaque haemorrhage. The aim of this trial was to determine the influence of a physical activity intervention on plaque instability in asymptomatic patients with carotid stenosis.
is a randomized clinical trial (ID-RCB:2019-A01543-54/SI:19.06.21.40640; registered on clinicaltrials.govNCT04053166). Patients were enrolled at University Hospital of Lyon, France, from December 2019 to March 2022. Fifty-six asymptomatic patients with carotid artery stenosis ≥50% NASCET were included and randomized 1:1 in an interventional physical activity arm or a control arm. The interventional arm underwent 6 months of an individualized home-based physical activity program, while the control arm followed usual care. The main outcome is the variation of the intraplaque haemorrhage score measured with high-resolution magnetic resonance imaging of the carotid plaque. All data were analysed with an intention to treat. Investigators were blinded from grouping.
Out of 52 patients participating in the trial, 26 were allocated in each arm. The intraplaque haemorrhage score was significantly reduced over time in the physical activity arm (estimate difference: -0.32 ± 0.15, [95% CI -0.63 to -0.01], p = 0.04). The physical activity arm had increased daily step counts at the end of the 6-month intervention compared to the control arm (1843 ± 758, [CI95% 313-3373], p = 0.02).
This trial demonstrates that an individualized home-based physical activity intervention could reduce the severity of intraplaque haemorrhage detected by magnetic resonance imaging and that it is feasible in asymptomatic patients with carotid atherosclerotic plaque. These results suggest that this type of moderate-intensity physical activity could be included in this population to the best medical treatment.
This study was funded by the and .
无症状颈动脉粥样硬化斑块患者的管理仍存在争议。通过磁共振成像测量的斑块内出血是斑块不稳定和缺血风险的最佳指标。一项横断面研究报告称，体育活动与较低的颈动脉斑块内出血患病率相关。本试验的目的是确定体育活动干预对无症状颈动脉狭窄患者斑块不稳定的影响。
这是一项随机临床试验（ID-RCB：2019-A01543-54/SI：19.06.21.40640；在clinicaltrials.gov上注册，NCT04053166）。2019年12月至2022年3月期间，患者在法国里昂大学医院入组。纳入56例无症状颈动脉狭窄≥50%（北美症状性颈动脉内膜切除术标准）的患者，并按1:1随机分为介入性体育活动组或对照组。介入组接受为期6个月的个体化居家体育活动计划，而对照组接受常规护理。主要结局是通过颈动脉斑块的高分辨率磁共振成像测量的斑块内出血评分的变化。所有数据均采用意向性分析。研究人员对分组情况不知情。
在参与试验的52例患者中，每组分配26例。体育活动组的斑块内出血评分随时间显著降低（估计差异：-0.32±0.15，[95%置信区间-0.63至-0.01]，p=0.04）。与对照组相比，体育活动组在6个月干预结束时的每日步数增加（1843±758，[95%置信区间313-3373]，p=0.02）。
本试验表明，个体化居家体育活动干预可降低磁共振成像检测到的斑块内出血严重程度，且对无症状颈动脉粥样硬化斑块患者可行。这些结果表明，这种中等强度的体育活动可纳入该人群的最佳药物治疗方案中。
本研究由 和 资助。
