Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack
Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack
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斑块特征和血流动力学导致缺血性中风和短暂性脑缺血发作患者的神经功能损伤
DOI：
10.1007/s00330-020-07327-1
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发表时间：
2020-09-30
影响因子：
5.9
通讯作者：
Xia, Shuang
中科院分区：
文献类型：
--
作者：
Liu, Song;Tang, Ruowei;Xia, Shuang
目的探讨缺血性脑卒中和短暂性脑缺血发作（TIA）患者大脑中动脉（MCA）斑块和血流动力学的差异，并建立缺血性卒中和神经功能损害的预测模型。回顾性审查了2016年9月至2018年8月期间的分辨率血管壁成像。根据弥散加权成像和神经系统检查，将患者分为卒中组或TIA组。采用RApid Processing灌注和扩散软件计算动脉粥样硬化斑块特征和动脉顺行性积分（AnS），Tmax > 6.0-s体积。进行多因素Logistic回归分析和多元线性回归分析，以建立一个预测模型不可逆的梗死发生率和临床severity.Results45例患者被分配到中风组，22例被分配到TIA组。斑块长度、斑块内出血、强化、AnS、Tmax> 6.0-s体积在两组间有显著性差异（p< 0.05）。IPH和AnS是脑卒中患者的独立预测因子Tmax > 6.0 s容量、IPH、高血压和AnS与美国国立卫生研究院卒中量表（NIHSS）评分高相关结论IPH和AnS对脑卒中的发生有预测价值，Tmax > 6.0 s容积、IPH、高血压、缺血性卒中和TIA患者的斑块特征和血流动力学不同。·斑块内出血和顺行性评分对缺血性卒中具有较高的诊断效率。Tmax > 6.0-s体积、斑块内出血、高血压和顺行评分的组合可以预测患者的国立卫生研究院卒中量表评分。
ObjectivesWe aimed to investigate differential characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), and to develop a predictive model for the presence of ischemic stroke and neurological impairment.MethodsSixty-seven patients with acute ischemic events in MCA territory who underwent high-resolution vessel wall imaging between September 2016 and August 2018 were reviewed retrospectively. Patients were assigned to either the stroke group or TIA group, according to diffusion-weighted imaging and neurological examination. Plaque characteristics and anterograde score (AnS) were calculated.Tmax > 6.0-s volume was acquired by RApid Processing of perfusIon and Diffusion software. Multivariate logistic regression analysis and multiple linear regression analysis were performed to establish a predictive model for irreversible infarction occurrence and clinical severity.ResultsForty-five patients were assigned to the stroke group, and 22 were assigned to the TIA group. Plaque length, intraplaque hemorrhage (IPH), enhancement, AnS, andTmax > 6.0-s volumes were significantly different between the two groups (p< 0.05). IPH and AnS were independent predictors for patients with stroke (p= 0.020 and 0.034, respectively).Tmax > 6.0-s volume, IPH, hypertension, and AnS were associated with high National Institutes of Health Stroke Scale (NIHSS) scores (allp< 0.05,R= 0.725, and adjustedR2= 0.494).ConclusionsIPH and AnS are useful in predicting stroke occurrence.Tmax > 6.0-s volume, IPH, hypertension, and AnS are associated with neurological impairment of the patients.Key Points• Ischemic stroke and TIA patients have different plaque characteristics and hemodynamics.• Intraplaque hemorrhage and anterograde score have high diagnostic efficiency for ischemic stroke.• The combination of Tmax > 6.0-s volume, intraplaque hemorrhage, hypertension, and anterograde score can predict the National Institutes of Health Stroke Scale scores of patients.