症状性颈动脉系统动脉硬化斑块颅内外分布的相关性研究

Correlation between intracranial and extracranial symptomatic carotid atherosclerotic plaques

目的探讨症状性颈动脉系统粥样硬化斑块颅内、外分布的相关性。方法选取有脑梗死或短暂性脑缺血发作患者55例,其中脑梗死27例(49.1%),短暂性脑缺血发作28例(50.9%),同时进行颅内、外颈动脉MRI,分析两者之间的相关性。结果颅外颈动脉:最大管壁厚度、粥样硬化斑块累及范围及管腔狭窄程度分别为(3.7±1.6)mm、(27.7±15.0)mm及(37.9±30.6)%;37例(67.3%)斑块内伴有钙化,24例(43.6%)斑块内伴有出血,25例(45.5%)斑块内伴有富脂质坏死核,13例(23.6%)斑块表面纤维帽破裂;颅内颈动脉:大脑中动脉及前循环(包括大脑前、中动脉)的管腔狭窄度分别为(37.2±26.5)%和(37.5±26.2)%。大脑中动脉狭窄与颅外颈动脉狭窄及最大管壁厚度有相关性(r=0.866,r=0.564,P<0.01)。前循环狭窄与颅外颈动脉狭窄及最大管壁厚度有相关性(r=0.879,r=0.598,P<0.01)。结论颅内、外颈动脉粥样硬化性疾病的严重性之间有显著的相关性。颅外颈动脉粥样硬化性斑块可以作为预测颅内颈动脉粥样硬化性疾病的严重程度指标。

Objective To study the correlation between intracranial and extracranial symptomatic carotid atherosclerotic plaques.Methods Of the 55 ischemic stroke patients included in this study,27 （49.1％） were ischemic stroke patients and 28 （50.9％） were transient ischemic stroke patients.The patients underwent intracranial and extracranial carotid artery MRI.Correlation between intracranial and extracranial carotid atherosclerotic plaques was analyzed.Results The MaxWT,atherosclerotic plaques-involved area and luminal stenosis was 3.7 ± 1.6 mm,27.7 ±15.0 mm,and 37.9％±30.6％,respectively.Of the 55 ischemic stroke patients,37 （67.3％） presented with intraplaque calcification,24 （43.6％） presented with intraplaque hemorrhage,25 （45.5％） presented with lipid-rich necrotic core,and 13 （23.6％） presented with ruptured fibrous cap on the surface of plaques.The luminal stenosis accounted for 37.2％±-26.5％ in middle cerebral artery and 37.5％ ±26.2％ in anterior circulation artery.The MCA stenosis and anterior circulation artery stenosis were significantly correlated with the carotid MaxWT （r=0.866,r=0.598,P＜0.01）.Conclusion The severity of intracranial atherosclerotic diseases is closely related with that of extracranial atherosclerotic diseases.Extracranial artery therosclerotic plaques can be used as a predictor for intracranial artery atherosclerotic diseases and their severity.