CTA探讨颈动脉几何形态与粥样硬化斑块的关系

Relationship between carotid geometry and carotid atherosclerotic plaques by CTA

目的利用CT血管成像(CTA)探讨颈动脉几何形态与颈内动脉起始部粥样硬化斑块形成的相关性。方法收集我院2017年6月~2018年3月经头颈部CTA检查的患者246例,共检测492侧颈动脉血管形态、管腔结构及分叉处解剖结构,并检查颈内动脉起始部是否存在粥样硬化斑块。所有患者中只有单侧血管存在斑块的患者共54例(108侧),将整体情况下全部血管(492侧血管)及同一个体只有单侧血管存在斑块患者的两侧血管(108侧血管)分别分成两组,即有斑块组与无斑块组,分别比较两组间各种颈动脉分叉几何形态的差异。结果492侧血管中,有154侧颈内动脉起始部存在粥样硬化斑块;颈动脉分叉的TF-AHCB分型呈A型118侧,斑块37侧;呈B型252侧,斑块75侧;呈C型122侧,斑块42侧;B型所占构成比明显高于A、C型;颈动脉分叉角度球形分型呈Ⅰ型72侧,斑块16侧;呈Ⅱ型138侧,斑块28侧;呈Ⅲ型99侧,斑块28侧;呈Ⅳ型183侧,斑块82侧;Ⅳ型构成比明显高于其他几型。同一个体的颈动脉TF-AHCB分型和角度球形分型,两组之间差异无统计学意义(P>0.05);整体情况下,颈内动脉窦最宽径、颈总动脉直径、颈总动脉分叉角度和颈动脉TF-AHCB分型,两组之间差异亦无统计学意义(P>0.05);但整体情况下颈动脉角度球形分型,两组之间差异有统计学意义(P<0.05),其中大角大球型最易形成颈内动脉粥样硬化斑块(P<0.0083)。结论同一个体颈动脉分叉部几何形态差异与颈内动脉起始部粥样硬化斑块形成无显著相关性,但整体情况下颈动脉分叉角度和颈动脉球越大,则颈内动脉起始部越易形成粥样硬化斑块。

ObjectiveTo investigate the correlation between carotid geometry and atherosclerotic plaque formation at the beginning of internal carotid artery by CT angiography (CTA). Methods246 patients with CTA examination in the head and neck were collected. The morphology, lumen structure and bifurcation structure of the 492 sides of carotid artery were detected. The atherosclerotic plaques were detected in the initial part of the internal carotid artery. 54 cases (108 sides of blood vessels) were found in all patients with only unilateral vascular plaque. The whole condition (492 sides of blood vessels) and the two vessels of the same individual (108 sides of blood vessels) were divided into plaque and no plaque groups. The differences of the geometric shape of carotid bifurcation were analyzed. ResultsIn the 492 vessels, there were 154 atherosclerotic plaques in the initial part of the internal carotid artery. The TF-AHCB classification of carotid bifurcation was 118 sides of type A, including 37 sides of plaque, 252 sides of type B, 75 sides of plaque, 122 side of type C, 42 side of plaque. The proportion of B type was significantly higher than that of other two types. The globular classification of the carotid bifurcation was 72 sides of type I, 16 sides of plaque, 138 sides of type II, 28 sides of plaque, 99 sides of type III ,28 sides of plaque, 183 side of type IV, 82 sides of plaque. The ratio of type IV was significantly higher than of the others. In the same individual, there was no significant difference between the two groups in carotid artery TF-AHCB typing and angle spherical classification ( P >0.05). On the whole, the width of the internal carotid sinus, the diameter of the common carotid artery, the bifurcation angle of the common carotid artery and the TF-AHCB classification of the carotid artery were not statistically different between the two groups ( P >0.05). However, there were statistically significant differences between the two groups ( P < 0.05) in the overall carotid angle globular classification. The large angle big ball was the most likely to form the carotid atherosclerotic plaque ( P < 0.0083). ConclusionThere was no significant correlation between geometric differences of carotid bifurcation and atherosclerotic plaque formation at the beginning of internal carotid artery in the same individual. However, in general, the greater the bifurcation angle of the stiff artery and the larger the carotid bulb, the more likely the origin of the internal carotid artery to form atherosclerotic plaques.