Hatsukami T S, Ferguson M S, Beach K W, Gordon D, Detmer P, Burns D, Alpers C, Strandness D E
Seattle Veterans Affairs Medical Center, WA 98108, USA.
Stroke. 1997 Jan;28(1):95-100. doi: 10.1161/01.str.28.1.95.
Studies have suggested that B-mode ultrasonography can be used to determine carotid plaque composition and that specific plaque characteristics are associated with a worse clinical outcome. However, histological studies examining the relationship between carotid plaque morphology and clinical outcome have reported conflicting findings. Furthermore, few investigators have described plaque morphology in quantifiable terms. This study examines the association between the volume of carotid plaque constituents and preoperative ischemic neurological symptoms. Constituents examined were chosen based on their potential for identification by current diagnostic imaging modalities such as ultrasound or MRI.
Atherosclerotic plaques from 43 patients undergoing carotid endarterectomy were examined histologically, with sections obtained every 0.5 to 1 mm. The lesions were examined for the presence and quantity of fibrous intimal tissue, intraplaque hemorrhage, lipid core, necrotic plaque core, and calcification. The quantity of each constituent was compared in plaques removed from symptomatic patients with those excised from asymptomatic individuals. Differences were analyzed with a Kolmogorov-Smirnov statistic.
There was no difference between plaques removed from asymptomatic and symptomatic patients with regard to the presence and volume of fibrous intimal tissue, intraplaque hemorrhage, the lipid core, the necrotic core, or calcification.
In patients with highly stenotic carotid lesions who are undergoing carotid endarterectomy, gross plaque composition is similar regardless of preoperative symptom status. Given this similarity, it is unlikely that differences in the volume of intraplaque hemorrhage, lipid core, necrotic core, or calcification in atherosclerotic carotid plaques explain their embolic history.
研究表明，B 型超声可用于确定颈动脉斑块成分，且特定的斑块特征与较差的临床结局相关。然而，关于颈动脉斑块形态与临床结局之间关系的组织学研究结果相互矛盾。此外，很少有研究者用可量化的术语描述斑块形态。本研究旨在探讨颈动脉斑块成分体积与术前缺血性神经症状之间的关联。所检查的成分是根据其能否通过超声或 MRI 等当前诊断成像方式识别来选择的。
对 43 例行颈动脉内膜切除术患者的动脉粥样硬化斑块进行组织学检查，每隔 0.5 至 1 毫米获取切片。检查病变中纤维内膜组织、斑块内出血、脂质核心、坏死斑块核心和钙化的存在情况及数量。比较有症状患者切除的斑块与无症状个体切除的斑块中各成分的数量。采用 Kolmogorov-Smirnov 统计量分析差异。
在纤维内膜组织、斑块内出血、脂质核心、坏死核心或钙化的存在情况及体积方面，无症状患者和有症状患者切除的斑块之间无差异。
在接受颈动脉内膜切除术的高度狭窄颈动脉病变患者中，无论术前症状状态如何，大体斑块成分相似。鉴于这种相似性，动脉粥样硬化性颈动脉斑块内出血、脂质核心、坏死核心或钙化体积的差异不太可能解释其栓塞病史。
