BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening ...BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.展开更多
This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography....This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.展开更多
Objective:To evaluate the values of Carotid Magnetic Resonance Imaging(MRI)in the differential diagnosis of symptomatic carotid stenosis and atherosclerotic plaque.Methods:56 patients with ischemic cerebrovascular dis...Objective:To evaluate the values of Carotid Magnetic Resonance Imaging(MRI)in the differential diagnosis of symptomatic carotid stenosis and atherosclerotic plaque.Methods:56 patients with ischemic cerebrovascular disease admitted in our hospital from October 2018 to October 2019 were selected and treated with Carotid MRI and digital subtraction angiography(DSA)examinations.According to the two examination results recorded and the“gold standard”of DSA examination,values of Carotid MRI in the differential diagnosis of symptomatic carotid stenosis were evaluated.Results:According to the“gold standard”of DSA examination,the sensitivity and specificity of MRI examination for carotid stenosis were:Mild:92.54%and 97.78%;Moderate:85.71%and 88.78%;Severe:100.00%and 97.8%;and complete occlusion:100.00%and 100.00%;The proportions of intraplaque haemorrhage and ruptured fibrous cap in different degrees of carotid artery stenosis were:Mild:30.16%and 22.22%;Moderate:43.48%and 39.13%;And severe:57.89%and 52.63%.Conclusion:MRI examination can evaluate the degree of symptomatic carotid artery stenosis,and show the characteristics of atherosclerotic plaque at the same time to provide a reference for early clinical differential diagnosis and treatment.展开更多
Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of...Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of 80 patients with TIA and carotid atherosclerotic plaque who were admitted in our hospital and confirmed by the ultrasound were included in the study and randomized into the treatment group and the control group (n = 40). The patients in the two groups were given TIA routine treatments and aspirin. On this basis, the patients in the treatment group were given atorvastatin calcium. The carotid ultrasound before treatment and 6 months after treatment in the two groups was performed to compare the atherosclerotic plaque area and IMT. The serum lipid level and cerebral hemodynamic parameters were detected. Results:IMT and carotid plaque area after treatment in the treatment group were significantly reduced when compared with before treatment (P<0.05). IMT and carotid plaque area after treatment in the treatment group were significantly lower than those in the control group (P<0.05). The comparison of TC, TG, LDL, and HDL levels before treatment between the two groups was not statistically significant (P>0.05). TC, TG, and LDL levels after treatment were significantly reduced when compared with before treatment (P<0.05), while HDL level was significantly elevated when compared with before treatment (P<0.05). TC, TG, and LDL levels after treatment in the treatment group were significantly lower than those in the control group (P<0.05), while HDL level was significantly higher than that in the control group (P<0.05). The average blood velocity and average blood flow volume of cerebral circulation after treatment in the treatment group were significantly higher than those in the control group (P<0.05), while the cerebrovascular characteristic resistance and peripheral resistance were significantly lower than those in the control group (P<0.05).Conclusions:Atorvastatin calcium in the treatment of TIA can significantly reduce the serum lipid level, alleviate or stabilize the carotid atherosclerotic plaque, and improve the cerebral hemodynamic indicators, with a significant efficacy.展开更多
The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atheroscl...The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.展开更多
Objective:Application of microvascular imaging technique to evaluate the difference of blood flow imaging with different sonographic characteristics.Method:Selection in our hospital with carotid plaques in 120 patient...Objective:Application of microvascular imaging technique to evaluate the difference of blood flow imaging with different sonographic characteristics.Method:Selection in our hospital with carotid plaques in 120 patients,record 120 plaques on the patient's body, the thickness of endometrium by two-dimensional bounce and SMI technology to the patient, plaque morphology, acoustic characteristics, and the formation of new blood flow inside the plaque were analyzed.Result:The rate of neovascularization in the mixed echo plaques and hypoechoic plaques was significantly higher than that in the other two plaques, there was a difference in blood flow in all types of plaques. The internal echo between different patches of blood flow rate of appearance comparison, we can get a conclusion, no significant hypoechoic plaques and mixed plaques echo difference, compared with mixed echo plaque and medium echo, hyperechoic plaque had significant difference. Conclusion The SMI technique evaluated plaque blood flow imaging to obtain the followingConclusions: the rate of neovascularization in hypoechoic plaques and mixed echo plaques was significantly higher than that in moderate echo plaques and hyperechoic plaques,and SMI provides a new possibility for the diagnosis of neovascularization in atherosclerotic plaques and its manifestation in different echo plaques.展开更多
目的探讨溶栓胶囊联合阿司匹林治疗颈动脉硬化斑块的疗效。方法选取100例颈动脉粥样硬化斑块患者作为研究对象,用随机数字表法分为观察组(55例,用溶栓胶囊联合阿司匹林肠溶片治疗)和对照组(45例,用阿司匹林肠溶片治疗)。观察2组治疗后...目的探讨溶栓胶囊联合阿司匹林治疗颈动脉硬化斑块的疗效。方法选取100例颈动脉粥样硬化斑块患者作为研究对象,用随机数字表法分为观察组(55例,用溶栓胶囊联合阿司匹林肠溶片治疗)和对照组(45例,用阿司匹林肠溶片治疗)。观察2组治疗后的临床疗效、斑块情况、中医症状积分、血流变指标和不良反应发生情况。结果治疗后,观察组的临床总有效率(96.36%)高于对照组(80.00%),P<0.05。观察组患者的内-中膜的厚度(intima media thickness,IMT)和斑块面积分别为(0.95±0.16)mm、(19.34±1.47)mm^(2),均低于对照组[(1.24±0.18)mm、(20.33±1.87)mm^(2)];管腔直径[(6.47±0.48)mm]大于对照组[(5.53±0.43)mm],P<0.05。治疗后,观察组患者的头晕、头刺痛、肢体麻木、口唇紫暗中医症候积分分别为(1.02±0.56)、(2.02±1.48)、(2.34±0.47)、(2.26±1.22)分,均低于对照组[(2.34±0.43)、(3.20±1.03)、(3.33±1.87)、(3.51±1.49)分],P<0.05。治疗后,观察组全血黏度低切、中切、高切及血浆黏度均低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论溶栓胶囊联合阿司匹林肠溶片治疗颈动脉硬化斑块能提高临床疗效,改善斑块情况,降低中医证候积分,改善血流变指标,且无明显不良反应发生,安全性较高。展开更多
基金Supported by Shanghai Jiading District Health and Family Planning Commission Health Planning Commission Scientific Research Project,No.KYXM,2015-KY-02
文摘BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.
文摘This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.
文摘Objective:To evaluate the values of Carotid Magnetic Resonance Imaging(MRI)in the differential diagnosis of symptomatic carotid stenosis and atherosclerotic plaque.Methods:56 patients with ischemic cerebrovascular disease admitted in our hospital from October 2018 to October 2019 were selected and treated with Carotid MRI and digital subtraction angiography(DSA)examinations.According to the two examination results recorded and the“gold standard”of DSA examination,values of Carotid MRI in the differential diagnosis of symptomatic carotid stenosis were evaluated.Results:According to the“gold standard”of DSA examination,the sensitivity and specificity of MRI examination for carotid stenosis were:Mild:92.54%and 97.78%;Moderate:85.71%and 88.78%;Severe:100.00%and 97.8%;and complete occlusion:100.00%and 100.00%;The proportions of intraplaque haemorrhage and ruptured fibrous cap in different degrees of carotid artery stenosis were:Mild:30.16%and 22.22%;Moderate:43.48%and 39.13%;And severe:57.89%and 52.63%.Conclusion:MRI examination can evaluate the degree of symptomatic carotid artery stenosis,and show the characteristics of atherosclerotic plaque at the same time to provide a reference for early clinical differential diagnosis and treatment.
文摘Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of 80 patients with TIA and carotid atherosclerotic plaque who were admitted in our hospital and confirmed by the ultrasound were included in the study and randomized into the treatment group and the control group (n = 40). The patients in the two groups were given TIA routine treatments and aspirin. On this basis, the patients in the treatment group were given atorvastatin calcium. The carotid ultrasound before treatment and 6 months after treatment in the two groups was performed to compare the atherosclerotic plaque area and IMT. The serum lipid level and cerebral hemodynamic parameters were detected. Results:IMT and carotid plaque area after treatment in the treatment group were significantly reduced when compared with before treatment (P<0.05). IMT and carotid plaque area after treatment in the treatment group were significantly lower than those in the control group (P<0.05). The comparison of TC, TG, LDL, and HDL levels before treatment between the two groups was not statistically significant (P>0.05). TC, TG, and LDL levels after treatment were significantly reduced when compared with before treatment (P<0.05), while HDL level was significantly elevated when compared with before treatment (P<0.05). TC, TG, and LDL levels after treatment in the treatment group were significantly lower than those in the control group (P<0.05), while HDL level was significantly higher than that in the control group (P<0.05). The average blood velocity and average blood flow volume of cerebral circulation after treatment in the treatment group were significantly higher than those in the control group (P<0.05), while the cerebrovascular characteristic resistance and peripheral resistance were significantly lower than those in the control group (P<0.05).Conclusions:Atorvastatin calcium in the treatment of TIA can significantly reduce the serum lipid level, alleviate or stabilize the carotid atherosclerotic plaque, and improve the cerebral hemodynamic indicators, with a significant efficacy.
文摘The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.
文摘Objective:Application of microvascular imaging technique to evaluate the difference of blood flow imaging with different sonographic characteristics.Method:Selection in our hospital with carotid plaques in 120 patients,record 120 plaques on the patient's body, the thickness of endometrium by two-dimensional bounce and SMI technology to the patient, plaque morphology, acoustic characteristics, and the formation of new blood flow inside the plaque were analyzed.Result:The rate of neovascularization in the mixed echo plaques and hypoechoic plaques was significantly higher than that in the other two plaques, there was a difference in blood flow in all types of plaques. The internal echo between different patches of blood flow rate of appearance comparison, we can get a conclusion, no significant hypoechoic plaques and mixed plaques echo difference, compared with mixed echo plaque and medium echo, hyperechoic plaque had significant difference. Conclusion The SMI technique evaluated plaque blood flow imaging to obtain the followingConclusions: the rate of neovascularization in hypoechoic plaques and mixed echo plaques was significantly higher than that in moderate echo plaques and hyperechoic plaques,and SMI provides a new possibility for the diagnosis of neovascularization in atherosclerotic plaques and its manifestation in different echo plaques.
文摘目的探讨溶栓胶囊联合阿司匹林治疗颈动脉硬化斑块的疗效。方法选取100例颈动脉粥样硬化斑块患者作为研究对象,用随机数字表法分为观察组(55例,用溶栓胶囊联合阿司匹林肠溶片治疗)和对照组(45例,用阿司匹林肠溶片治疗)。观察2组治疗后的临床疗效、斑块情况、中医症状积分、血流变指标和不良反应发生情况。结果治疗后,观察组的临床总有效率(96.36%)高于对照组(80.00%),P<0.05。观察组患者的内-中膜的厚度(intima media thickness,IMT)和斑块面积分别为(0.95±0.16)mm、(19.34±1.47)mm^(2),均低于对照组[(1.24±0.18)mm、(20.33±1.87)mm^(2)];管腔直径[(6.47±0.48)mm]大于对照组[(5.53±0.43)mm],P<0.05。治疗后,观察组患者的头晕、头刺痛、肢体麻木、口唇紫暗中医症候积分分别为(1.02±0.56)、(2.02±1.48)、(2.34±0.47)、(2.26±1.22)分,均低于对照组[(2.34±0.43)、(3.20±1.03)、(3.33±1.87)、(3.51±1.49)分],P<0.05。治疗后,观察组全血黏度低切、中切、高切及血浆黏度均低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论溶栓胶囊联合阿司匹林肠溶片治疗颈动脉硬化斑块能提高临床疗效,改善斑块情况,降低中医证候积分,改善血流变指标,且无明显不良反应发生,安全性较高。
