责任斑块狭窄度及颅内斑块总数与复发性卒中相关:基于高分辨血管壁成像的单中心病例对照研究

The stenotic culprit plaque and the total number of intracranial plaques associated with recurrent stroke:a single-center case-control study based on vessel wall imaging

目的:颅内动脉粥样硬化斑块特征是与复发性卒中相关的潜在因素,但以往的研究多集中于单一病变,少有研究同时对颅内斑块数进行分析。本研究旨在探讨全脑斑块特征与卒中复发之间的关系。方法:回顾性收集颅内动脉粥样硬化性急性缺血性卒中患者,并将其分为首次卒中组与复发性卒中组。患者均行高分辨血管壁成像,并对颅内斑块数及责任斑块特征(如斑块面积、斑块体积、斑块负荷、狭窄程度、强化率等)进行评估。采用Logistic回归分析以明确与复发性卒中患者独立相关的因素。结果:共106例患者(男65例,女41例,平均(58±12)岁)纳入分析,其中48例患者为复发性卒中,58例患者为首次卒中。相对于首次卒中组患者,复发性卒中患者的年龄更大((62±9)岁vs.(55±13)岁,P=0.03),糖尿病患者比例更高(58.3%vs.37.9%,P=0.04),责任斑块狭窄度更高(72.73%vs. 61.36%,P=0.02),具有更多的颅内斑块(5个斑块vs. 4个斑块,P=0.01)。责任斑块的其他HR-VWI特征在两组间并无统计学差异。校正临床因素(年龄和糖尿病)后,责任斑块的狭窄度(OR 1.47每增加10%;95%CI 1.08~2.00;P=0.01)和颅内斑块总数(OR 1.34;95%CI 1.08~1.67;P=0.01)是与复发性卒中患者独立相关的影像学特征。联合以上因素可将AUC值提高至0.71,高于任一单独变量的AUC值。结论:更为狭窄的责任斑块和更多的颅内斑块与复发性卒中独立相关。对患者进行全脑血管壁成像可协助临床优化识别具有高复发风险的卒中患者。

Objective: Intracranial atherosclerotic plaque features were potential factors associated with recurrent stroke, but previous studies mostly focused on a single lesion, and few studies evaluated the total number of intracranial atherosclerotic plaques. This study aimed to investigate the association between whole-brain plaque features and stroke recurrence. Methods:Patients with acute ischemic stroke due to intracranial atherosclerosis were retrospectively collected and divided into first-time stroke group and recurrent stroke group. All patients underwent high-resolution vessel wall imaging. Intracranial plaque number and culprit plaque features(such as plaque area, plaque volume, plaque burden, degree of stenosis, enhancement ratio, etc.)were evaluated and recorded. Logistic regression analyse was used to determine the independent factors associated with recurrent stroke. Results: A total of 106 patients(65 males, 41 females,(58±12) years old) were included in the analysis, including48 patients with recurrent stroke and 58 patients with first-time stroke. Compared with patients in the first-time stroke group,patients in the recurrent stroke group were older((62±9) vs.(55±13), P=0.03) with more diabetic patients(58.3% vs. 37.9%, P=0.04), had more stenotic culprit plaques(72.73% vs. 61.36%, P=0.02), and more intracranial plaques(5 plaques vs. 4 plaques,P=0.01). There was no significant difference in other HR-VWI characteristics of culprit plaque between the two groups. After adjusting clinical factors(age and diabetes), stenotic degree of culprit plaque(OR 1.47, per 10% increase;95%CI 1.08~2.00;P=0.01), and the total number of plaque(OR 1.34;95% CI 1.08 ~1.67;P =0.01) were independently associated with recurrent stroke. Combined with the above factors, the AUC value was increased to 0.71, which was higher than that of any single variable. Conclusion: More stenotic culprit plaque, and more intracranial plaques are independently associated with recurrent stroke. Whole-brain vessel wall imaging can help clinical optimization to identify stroke patients with higher risk of recurrent.