CTA下颈动脉斑块负荷与前循环缺血性脑卒中远期复发事件的相关性研究

Study on the Correlation between Carotid Plaque Burden with CTA and Long_term Recurrence of Anterior Circulation Ischemic Stroke in Patients

目的探讨急性前循环脑梗死患者远期卒中事件和CT血管(CT Angiography,CTA)下的颈动脉粥样硬化斑块影像学特征的相关性。方法分析106例急性前循环脑梗死患者,利用CTA影像测量斑块体积、狭窄程度、重塑指数及脂质核心体积等。随访3年后记录其远期缺血性脑卒中事件。利用多元逻辑回归分析,评估颈动脉斑块的影像学特征与终点事件的相关性。结果 106例患者中,向心性斑块64例(60.38%),离心性斑块32例(30.19%),斑块体积为(41.02±19.39)mm3,脂质核心体积为(24.17±21.52)mm3;共有32次缺血性脑卒中事件。脂质核心体积是缺血性脑卒中复发最重要的预测因素,脂质核心越大,随访期出现终点事件的可能性越大(OR=1.07,P<0.01)。结论急性缺血性脑卒中的CTA影像可用于评估颈动脉斑块的多种特征,并用于远期卒中事件风险的预测,有利于制定合理的二级预防策略。

Objective To investigate the correlation between long-term stroke events of acute anterior circulation cerebral infarction and imaging features of carotid atherosclerotic plaque on CT Angiography （CTA）. Methods 106 patients with acute cerebral infarction caused by the occlusion of anterior circulation were included in this study. The volume of plaque, stenosis degree, remodeling index and lipid core volume were measured by CTA images. After 3 years of follow-up, the long-term iscbemic stroke events were recorded. Using multi-variables logistic regression analysis, the correlation between imaging features of carotid atherosclerotic plaque on CTA and endpoint events were assessed. Results Of 106 eases included, 64 cases had centricity plaque （60.38%） and 32 cases had ec- ceutricity plaque （30.19%）. Mean plaque volume was （41.02 ± 19.39）mm^3 and mean lipid necrotic core volume was （24.17± 21.52）mm^3. There were 32 cases of ischemic stroke events. Lipid necrotic core volume was the most important predictor for recur- rence of isehemic stroke. There was a positive correlation between the lipid core volume and endpoint events incidence （ OR = 1.07, P 〈 0.01 ）. Conclusions Assessment of carotid atherosclerotic plaque with CTA images in acute ischemic stroke patients, which can be used prediction the risk of further ischemie stroke events, is conducive to make a reasonable secondary prevention strategy.