颈动脉CT斑块特征与颈动脉支架成形术后新发脑缺血灶的相关性

Association between CT features of carotid plaque and new brain ischemic lesions after carotid artery stenting

目的研究颈动脉斑块CT特征与颈动脉支架成形术(carotid artery stenting,CAS)术后新发脑缺血灶(new brain ischemic lesion,NBIL)的关系。方法回顾性分析123例行CAS的颈动脉狭窄患者。所有患者于术前接受颈动脉CT成像(computed tomography angiography,CTA)检查,所有患者于术前及术后接受头颅DWI-MRI检查。区分软斑块、混合斑块及钙化斑块的颈动脉斑块成分。评价及测量分析斑块的表面形态、长度、各类型斑块的体积及厚度,钙化斑块的位置及范围。采用单因素和多因素Logistic回归分析CT斑块特征与CAS术后NBIL的关系。结果术后共有61例患者出现NBIL。NBIL(+)组钙化斑块厚度大于NBIL(-)组[(1.79±1.38)mm vs.(1.38±0.83)mm,P=0.020]。NBIL(+)组内膜钙化的发生率高于NBIL(-)组(34.4%vs. 8.1%,P=0.002)。多因素回归分析显示内膜钙化(OR=15.65,95%CI:1.34~98.75)及钙化斑块厚度(OR=1.35,95%CI:0.89~1.90)与NBIL相关。ROC曲线显示当狭窄处钙化厚度大于1.75 mm时其曲线下面积为0.726,其预测的特异性为88.7%。结论颈动脉CT上显示的钙化位置及钙化厚度与CAS术后发生NBIL相关。

Objective To assess the relationship between carotid plaque features analyzed using CT and new brain ischemic lesion(NBIL)after carotid artery stenting computed tomography angiography(CAS).Methods One hundred and twenty-three patients with carotid stenosis undergoing CAS were retrospectively enrolled in the study.All the patients underwent preprocedural carotid CT and preoperative and postoperative brain DWI-MRI.Components of the carotid plaque including soft,mixed and calcified plaque were identified.The surface morphology,length,volumes and thickness of each plaque,and the location and extent of calcified plaque were assessed and analyzed.Univariate and multivariate Logistic regression analysis was used to assess the correlation between CT features of carotid plaque and NBIL.Results NBILs were detected in 61 patients.The maximum calcified plaque thickness of NBIL(+)group was significantly larger than that of NBIL(-)group[(1.79±1.38)mm vs.(1.38±0.83)mm,P=0.020].The NBIL(+)group had a significantly higher incidence of intimal calcification than NBIL(-)group(34.4%vs.8.1%,P=0.002).Multivariate logistic regression analysis revealed that intimal calcification(OR=15.65,95%CI:1.34-98.75)and the thickness of calcified plaque(OR=1.35,95%CI:0.89-1.90)were risk factors of NBIL after CAS.ROC curve showed that 1.75 mm of the CA thickness was the most reliable cutoff value(AUC=0.726)for predicting NBIL with a specificity of 88.7%.Conclusion Intimal calcification and the thickness of calcification are associated with increased risk of NBIL after CAS procedure.