CTA定量分析大脑中动脉闭塞性卒中斑块特征与侧支循环建立的关系

CTA Quantitative Analysis of the Relationship Between Plaque Characteristics and the Establishment of Collateral Circulation in Middle Cerebral Artery Occlusion Stroke

目的 采用CT血管造影(CTA)定量分析大脑中动脉(MCA)闭塞性卒中患者动脉斑块特征与侧支循环建立的关系。方法 选取2021年6月至2023年5月德阳市第二人民医院急诊入院的130例MCA闭塞性卒中患者,所有患者均接受CTA检查,定量分析患者动脉斑块特征,并评估侧支循环建立情况。然后将患者分为侧支循环不良组和侧支循环良好组,比较2组一般资料情况及动脉斑块特征。采用Logistic回归分析MCA闭塞性卒中患者侧支循环与动脉斑块特征主要参数的关系。绘制受试者工作特征(ROC)曲线,检验动脉斑块特征主要参数对MCA闭塞性卒中患者侧支循环建立的评估价值。结果 130例患者均按要求完成CTA检查,其中侧支循环不良37例,侧支循环良好93例。侧支循环不良组斑块长度、斑块负荷、偏心指数、脂质成分体积均大于侧支循环良好组,差异有统计学意义(P <0.05)。斑块负荷、偏心指数、脂质成分体积是MCA闭塞性卒中患者侧支循环建立的影响因素(P <0.05)。当MCA闭塞性卒中斑块负荷、偏心指数、脂质成分体积最佳截断值分别为38.295%、4.965、343.245 mm^(3)时,评估侧支循环的价值最高,曲线下面积均> 0.75 (P <0.05)。结论 MCA闭塞性卒中患者的侧支循环建立情况与斑块特征密切相关,尤其是斑块负荷、偏心指数及脂质成分体积。通过CTA定量分析这些斑块特征,可有效评估侧支循环的建立情况。

Objective To quantitatively analyze the relationship between the characteristics of arterial plaque and the establishment of collateral circulation in patients with middle cerebral artery(MCA)occlusive stroke by CT angiography(CTA).Methods A total of 130 patients with MCA occlusive stroke admitted to the emergency department of the Second People's Hospital of Deyang City from June 2021 to May 2023 were selected.All patients underwent CTA examination to quantitatively analyze the characteristics of arterial plaques and evaluate the establishment of collateral circulation.According to the evaluation results of collateral circulation,the patients were divided into a group with poor collateral circulation and a group with good collateral circulation.The data and arterial plaque characteristics of both groups were compared.Logistic regression was used to analyze the relationship between collateral circulation and arterial plaque characteristics in MCA occlusive stroke patients.Receiver operating characteristic(ROC)curves were drawn to test the evaluation value of the main parameters of arterial plaque characteristics on the establishment of collateral circulation in MCA occlusive stroke patients.Results 130 patients completed CTA examinations as required.Among them,37 cases had poor collateral circulation and 93 cases had good collateral circulation.The plaque length,plaque load,eccentricity index,and lipid component volume in the group with poor collateral circulation were all greater than those in the group with good collateral circulation,with statistically significant differences(P<0.05).The plaque load,eccentricity index,and lipid component volume were the influencing factors of collateral circulation establishment in MCA occlusive stroke patients(P<0.05).When the optimal cutoff values for plaque load,eccentricity index,and lipid component volume in MCA occlusive stroke were 38.295%, 4.965, and 343.245 mm^(3), respectively, the value of evaluating collateral circulation was highest, with area under the curve > 0.75 ( P < 0.05 ) . Conclusion The establishment of collateral circulation in patients with MCA occlusive stroke is closelyrelated to plaque characteristics, especially plaque load, eccentricity index, and lipid component volume. Quantitative analysis ofthese plaque characteristics by CTA can effectively evaluate the establishment of collateral circulation.