Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting
Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting
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颈动脉斑块扩张性动脉重塑是颈动脉支架置入术后缺血性并发症的危险因素
作者：
D. Kashiwazaki;N. Kuwayama;N. Akioka;K. Noguchi;S. Kuroda
背景颈动脉支架置入术（CAS）与颈动脉内膜切除术相比，围手术期卒中的风险更高。为了更好地选择患者，应该确定更准确的风险因素。本研究的目的是确定扩张动脉重塑是否可以预测接受 CAS 的患者的缺血性并发症。方法这项回顾性研究包括 82 名接受 CAS 治疗的颈动脉狭窄患者。在手术前使用 MR 斑块成像评估斑块成分。术后使用MRI弥散加权成像（DWI）进行病变评估，将患者分为DWI阳性或阴性，以进行组间比较。结果15名患者被归类为DWI阳性，67名患者被归类为DWI阴性。 DWI 阳性组的平均扩张重塑率为 1.76 ± 0.21，DWI 阴性组的平均扩张重塑率为 1.35 ± 0.18（P < 0.001）。接受者操作特征分析显示，区分两组的扩张重塑率阈值为 1.52（曲线下面积 = 0.933）。与高扩张重塑率相关的高强度斑块术后新DWI病灶的阳性预测值为64.3%，与低扩张重塑率相关的等强度斑块的阴性预测值为97.8%。这些值高于单独斑块成分的值（分别为 32.1% 和 81.7%）。 结论 这项研究表明，扩张性动脉重塑是 CAS 缺血性并发症的强有力的风险预测因子。扩展重塑率测量非常简单，为确定颈动脉狭窄患者的治疗策略提供了有用的信息。
BackgroundCarotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy. For better patient selection, more accurate risk factors should be identified. The aim of this study was to determine whether expansive arterial remodeling can predict ischemic complications in patients undergoing CAS.MethodsThis retrospective study included 82 patients with carotid stenosis treated by CAS. The plaque component was evaluated using MR plaque imaging before the procedure. Following the procedure, lesion assessment was performed using MRI diffusion-weighted imaging (DWI), and patients were classified as DWI positive or negative for comparison between groups.ResultsFifteen patients were classified as DWI positive and 67 patients as DWI negative. The mean expansive remodeling rate was 1.76 ± 0.21 in the DWI-positive group and 1.35 ± 0.18 in the DWI-negative group (P < 0.001). Receiver-operating characteristic analysis revealed that the threshold for the expansive remodeling rate separating the two groups was 1.52 (area under the curve = 0.933). The positive predictive value of postoperative new DWI lesions in the high-intensity plaque associated with a high expansive remodeling rate was 64.3%, and the negative predictive value of the isointensity plaque associated with a low expansive remodeling rate was 97.8%. These values were higher than those of the plaque component alone (32.1% and 81.7%, respectively).ConclusionsThis study revealed that expansive arterial remodeling is a strong risk predictor of ischemic complication in CAS. Expansive remodeling rate measurements are very simple and provide useful information for determining treatment strategies for patients with carotid stenosis.
DOI：
10.1056/nejmoa0912321
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
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作者：
Brott TG;Hobson RW 2nd;Howard G;Roubin GS;Clark WM;Brooks W;Mackey A;Hill MD;Leimgruber PP;Sheffet AJ;Howard VJ;Moore WS;Voeks JH;Hopkins LN;Cutlip DE;Cohen DJ;Popma JJ;Ferguson RD;Cohen SN;Blackshear JL;Silver FL;Mohr JP;Lal BK;Meschia JF;CREST Investigators
通讯作者：
CREST Investigators