Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign
Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign
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DOI：
10.1007/s10143-010-0270-9
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发表时间：
2010-10-01
影响因子：
2.8
通讯作者：
Kurisu, Kaoru
中科院分区：
文献类型：
--
作者：
Kume, Shinji;Hama, Seiji;Kurisu, Kaoru
移动的斑块与缺血性卒中风险增加相关，但定义尚不清楚。我们以前曾报道过颈动脉超声检查可以检测到颈动脉斑块表面的移动的成分，其上升和福尔斯的方式与动脉搏动性壁运动（水母征）不一致。然而，水母征的临床和病理特征仍不清楚。受试者包括165例颈动脉斑块和超声检查狭窄程度≥ 50%的患者。使用磁共振成像，我们量化斑块内出血（IPH），并定义缺血性中风的每一个病人。通过颈动脉内膜切除术获得15例手术标本，并将病理特征（纤维帽面积和斑块内粥样硬化病变）与超声斑块表面移动率进行比较。颈动脉斑块伴IPH者78例，水母征者31例。无IPH者未见水母征。在这15例患者中，纤维帽覆盖动脉粥样硬化病变，帽厚度与水母阳性斑块表面移动率呈负相关。Kaplan-Meier和考克斯多元回归分析显示，随访期间缺血性卒中最重要的预测因素是水母征，而不是IPH。水母征患者的卒中事件在诊断后短时间内重复。超声检查中的水母征是高危斑块易损性的标志，提示与血栓形成因子释放到动脉腔内相关的纤维帽破裂，并导致诊断后短时间内反复缺血性卒中。
Mobile plaque is associated with increased risk of ischemic stroke, but definitions have remained unclear. We have previously reported that carotid ultrasonography can detect the mobile component of the carotid plaque surface, which rises and falls in a manner inconsistent with arterial pulsatile wall motion (Jellyfish sign). However, clinical and pathological features of Jellyfish sign remain unclear. The subjects comprised of 165 patients with carotid plaque and degree of area stenosis >= 50% on ultrasonography. Using magnetic resonance imaging, we quantified intraplaque hemorrhage (IPH) and defined ischemic stroke in each patient. Fifteen surgical specimens were obtained by carotid endarterectomy, and pathological features (area of fibrous cap and intraplaque atheromatous lesion) were compared with ultrasonographic plaque surface movement rate. Carotid plaques with IPH were seen in 78 cases, with Jellyfish sign in 31 cases. Jellyfish sign was not detected in patients without IPH. In these 15 patients, the fibrous cap covered the atheromatous lesion, and cap thickness correlated negatively with Jellyfish-positive plaque surface movement rate. Kaplan-Meier and Cox multiple regression analysis demonstrated that the most important predictor of ischemic stroke during follow-up is Jellyfish sign, not IPH. Stroke events in patients with Jellyfish sign repeated within a short interval after diagnosis. Jellyfish sign on ultrasonography is a sign of high-risk plaque vulnerability, suggesting rupture of the fibrous cap associated with the release of thrombogenic factors into the arterial lumen, and resulting in repeated ischemic stroke during a short interval after diagnosis.