颈动脉活动性斑块的临床、超声及影像和病理学特征分析

Analysis of clinical,ultrasound,imaging and pathological features of floating carotid plaques

目的对颈动脉活动性斑块的临床、超声、影像和病理学特征及治疗方案进行分析,提高对该类疾病的认识。方法回顾性分析2012年1月-2016年12月5例超声检查发现颈动脉活动性斑块患者的临床资料。结果 5例患者中4例影像学表现为责任动脉供血区分水岭及皮质多发新鲜脑梗死。3例颈动脉超声检查显示为动脉粥样硬化性狭窄远端带蒂活动性斑块,2例为颈动脉斑块上膜样稍强回声信号,随心动周期做往复运动。3例行颈动脉内膜剥脱术,2例病理显示活动性斑块为吞噬脂质的组织细胞及胆固醇结晶聚集,1例显示动脉粥样硬化性斑块表面纤维帽不完整,表面可见纤维素样渗出。结论颈动脉活动性斑块是缺血性卒中的高危因素。其超声学及病理学特征不同,决定了其导致缺血事件发生的机制不同,在不能明确其性质的前提下,颈动脉内膜剥脱术可能是最佳的治疗方案。

Objective To explore the clinical,ultrasound,imaging and pathological features and treatment protocols of the floating carotid plaques. Methods The clinical data of 5 patients with floating carotid plaques were retrospectively analyzed. Results Among these patients,the imaging features of 4 patients were multiple acute cerebral infarctions in corresponding arterial area. Carotid artery ultrasound showed the floating plaque with the pedicle in the distal of atherosclerotic stenosis in 3 cases. 2 cases showed membrane-like strong echo signal on the carotid plaque. These plaques moved with cardiac cycle. 3 cases underwent carotid endarterectomy. Pathology showed that the floating plaque consisted of tissue cells ingesting the lipids and cholesterol clefts in 2 patients. 1 case showed that the fibrous cap was incomplete and fibrous exudation on the surface. Conclusion The floating carotid plaque is a high risk factor for ischemic stroke. Its ultrasonic and pathological characteristics are different,which determine the different mechanism of ischemic events. When the pathological nature of the active plaque is not confirmed,endarterectomy may be the best treatment.