基于CTA评价颈动脉斑块易损性与分布位置之间的相关性

Evaluation of the correlation between vulnerability and distribution location of carotid plaque based on CTA

摘要:

目的 利用CTA分析颈动脉斑块分布位置、特征与斑块易损性的关系，为颈动脉粥样斑块的危险因素及形成机制提供更多信息。方法 选取2020年10月至2021年10月连云港市第一人民医院收治的颈动脉粥样硬化患者且伴有短暂性脑缺血症状共89例。从CTA轴位测量颈动脉分叉处斑块的特征参数（斑块厚度、长度、最大横截面积、斑块负荷和重塑指数）和斑块分布位置，根据斑块是否具有高危特征（包括斑块内出血、富含脂质的坏死核心、斑块溃疡等），将斑块分为高危组和低危组，分析两组斑块的特征与分布位置的差异。结果 根据斑块高危特征，144条颈动脉中高危组79条，低危组65条。两组间的斑块厚度、长度、最大横截面积、斑块负荷、斑块分布差异有统计学意义（P<0.05）。在斑块横断面分布位置中，高危组较低危组相比更多见于颈动脉分叉处管壁背侧（P=0.002），且分布在背侧的斑块，其斑块厚度、长度、最大横截面积及斑块负荷较低危组更大（P<0.05）；低危组更倾向于分布在颈动脉分叉处外侧壁（P<0.01），且其斑块的最大横截面积及斑块负荷较高危组小（P<0.05），而两组颈动脉斑块的重构方式及狭窄率差异无统计学意义（P>0.05）。结论 高危斑块好发于颈动脉分叉处的背侧，且颈动脉分叉处斑块的厚度、横断面积及斑块负荷越大，斑块越倾向于不稳定，而低危斑块倾向于发生在颈动脉分叉外侧。

关键词:缺血性卒中;斑块易损性;动脉粥样硬化;斑块分布;颈动脉斑块

Abstract:

Objective To analyze the relationship among distribution location, characteristics, and vulnerability of carotid plaque using CTA and provide more information on the risk factors and formation mechanism of carotid atherosclerotic plaque.Methods We retrospectively analyzed the CTA images of the head and neck of 89 patients with carotid atherosclerosis. Atherosclerosis was developed in 144 carotid arteries. The plaques were divided into a high-risk plaque group and a low-risk plaque group according to whether the plaques had high-risk characteristics, and the differences in the characteristics and distribution locations of the plaques in the two groups were analyzed.The characteristic parameters of the cross-sectional plaques at the bifurcation of the carotid artery, including the thickness, remodelling index and distribution location of the plaques (ventral, dorsal, inner, and outer side walls) etc. were measured.Results Among 144 carotid arteries, 79 were classified as high-risk and 65 as low-risk groups. There were significant differences between the two groups concerning the thickness, length, maximum cross-sectional area, burden, and cross-sectional distribution of the plaques (P<0.05). The plaque distribution on the dorsal side wall of the carotid bifurcation was higher in the high-risk group than that in the low-risk group (P<0.05). The plaque distribution on the outer wall of the carotid bifurcation was higher in the low-risk group than in the high-risk group (P<0.05).Conclusion High-risk plaques tend to occur on the dorsal side wall of the carotid bifurcation, whereas low-risk plaques tend to occur on the outer side wall of the carotid bifurcation.

Key words:ischemic stroke;plaque vulnerability;atherosclerosis;plaque distribution;carotid artery plaque