无症状颈动脉狭窄患者颈动脉支架成形术后新发弥散加权成像病灶的危险因素分析

Risk factors for new diffusion weighted imaging lesions in patients with asymptomatic carotid stenosis after carotid artery stenting

目的应用高分辨MRI分析无症状颈动脉狭窄患者接受CAS后新发弥散加权成像(diffusion weighted imaging,DWI)病灶的危险因素。方法回顾性分析2017年1月至2019年5月在复旦大学附属中山医院接受CAS的216例无症状患者临床资料,通过单因素和多因素Logistic回归分析CAS术后新发DWI病灶的危险因素。结果CAS术后出现新发DWI病灶患者61例(28.24%)。Logistic回归分析结果显示,亚急性期斑块内出血(OR=20.167,95%CI=6.201~65.587,P<0.001)和开环支架的应用(OR=3.201,95%CI=1.251~8.189,P=0.015)显著增加CAS术后新发DWI病灶的风险,斑块内钙化是CAS术后新发梗死的保护性因素(OR=0.256,95%CI=0.101~0.647,P=0.004)。结论亚急性期斑块内出血和开环支架是无症状颈动脉狭窄患者CAS术后新发DWI病灶的独立危险因素。术前对无症状颈动脉狭窄患者行斑块MRI检查将有助于减少CAS术后脑梗死的发生风险。

Objective To analyze the risk factors of new diffusion weighted imaging(DWI)lesions after carotid artery stenting(CAS)in asymptomatic patients with carotid artery stenosis by high resolution magnetic resonance imaging.Methods The clinical data of asymptomatic carotid artery stenosis patients who treated by CAS in Zhongshan Hospital affiliated to Fudan University from January 2017 to May 2019 were analyzed retrospectively.Risk factors of new DWI lesions after CAS was analyzed by univariate analysis and multivariate logistic regression.Results The incidence of new DWI lesions after CAS was 28.24%(61 cases).Logistic regression analysis showed that subacute intraplaque hemorrhage(OR=20.167,95%CI=6.201~65.587,P<0.001)and open-cell stent(OR=3.201,95%CI=1.251~8.189,P=0.015)significantly increased the risk of new DWI after CAS.Plaque calcification is a protective factor for new cerebral infarction after CAS(OR=0.256,95%CI=0.101~0.647,P=0.004).Conclusion Subacute intraplaque hemorrhage and open-cell stent are independent risk factors for new DWI lesions in asymptomatic carotid stenosis patients after CAS.MRI examination of plaque for patients with asymptomatic carotid stenosis before surgery will help reduce the risk of cerebral infarction after CAS.