Holdsworth R J, McCollum P T, Bryce J S, Harrison D K
Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, Scotland.
Eur J Vasc Endovasc Surg. 1995 Jan;9(1):80-5. doi: 10.1016/s1078-5884(05)80229-1.
To study the relationship between carotid plaque morphology and the degree of stenosis on Duplex ultrasonography and symptoms.
Prospective open clinical study.
2,590 patients with 5,180 carotid arteries were scanned, 4,560 were initially analysed in terms of symptoms but 54 were excluded, leaving a total of 4,258.
Localising symptoms were present with respect to 1,342 vessels (29.4%). Two-thirds of symptomatic patients had normal carotid arteries. Tight stenosis (80-99%) was more likely to be associated with symptoms than low-grade (20-79%) stenosis (chi 2 = 28.0, p < 0.0001). Plaque type was identified in 1,558 bifurcations (36.6%). Heterogeneous type I & II plaques accounted for one third of plaques. There was a relationship between plaque morphology and degree of stenosis. At < 20% stenosis only 4.4% of plaques were heterogeneous whereas at 80-99% stenosis 84.5% of plaques were heterogeneous. Amaurosis fugax was the only symptom that had any association with a particular plaque morphology. Seventy-two percent of plaques associated with this symptom were heterogeneous in nature.
Carotid plaque morphology and degree of internal carotid stenosis are mutually dependent factors and both reflect the severity of atherosclerotic disease. Plaque morphology does not add to the sensitivity of stenosis in predicting the presence of symptoms.
研究双功超声检查中颈动脉斑块形态与狭窄程度及症状之间的关系。
前瞻性开放性临床研究。
对2590例患者的5180条颈动脉进行扫描，最初对4560条血管进行症状分析，但排除了54条，最终共有4258条血管纳入分析。
1342条血管（29.4%）出现定位症状。三分之二有症状的患者颈动脉正常。重度狭窄（80 - 99%）比轻度狭窄（20 - 79%）更易出现症状（卡方 = 28.0，p < 0.0001）。在1558个分叉处（36.6%）确定了斑块类型。I型和II型不均匀斑块占斑块总数的三分之一。斑块形态与狭窄程度之间存在关联。狭窄程度<20%时，仅4.4%的斑块为不均匀斑块，而狭窄程度在80 - 99%时，84.5%的斑块为不均匀斑块。一过性黑矇是唯一与特定斑块形态有关的症状。与该症状相关的斑块中，72%本质上为不均匀斑块。
颈动脉斑块形态和颈内动脉狭窄程度是相互依存的因素，均反映动脉粥样硬化疾病的严重程度。斑块形态在预测症状存在方面并未增加狭窄检测的敏感性。
