Evaluation Of Plaque Stability And Brain Carotid Artery Hemodynamics In Patients Undergoing Carotid Endarterectomy With Multimodal Ultrasound

Objective By analyzing the pathological findings and ultrasound findings of patients with carotid endarterectomy,to investigate the correlation between preoperative plaque stability and postoperative pathological findings in patients undergoing carotid endarterectomy with multimodal ultrasound.At the same time,ultrasound was used to monitor the blood flow of the brain and carotid artery at different time points before and after surgery,and the hemodynamic recovery was evaluated.Methods Forty-two patients who underwent carotid endarterectomy(CEA)underwent preoperative multimodal ultrasound with a target of 42stenosis-dependent plaques.There are symptomatic group and asymptomatic group according to the symptoms of ischemic stroke,transient ischemic attack(TIA)and transient black sputum caused by carotid stenosis in the past six months.The basic conditions of age,body mass index and blood pressure of the two groups were recorded before operation.Routine color Doppler ultrasound(CDUS)was used to detect plaque length,thickness,echo type,and presence or absence of ulcerated plaques.Contrast-enhanced ultrasound(CEUS)was used to detect semi-quantitative grading and quantification of neovascularization in plaques of the two groups.The PT,PI,BI and EI values of plaque angiography were evaluated.The stenosis Max YM,Min YM and Mean YM values were detected by shear wave elastography(SWE).The plaque stability of the two groups was evaluated according to the ultrasound results.Finally,the pathological results were used as the gold standard to compare the difference in plaque stability between the two groups,and the clinical application value of ultrasonography in the study of plaque stability.At the same time,ultrasound technique was used to monitor and compare the PSV,EDV,RI,PI of the internal carotid artery(ICA)and middle cerebral artery(MCA)in the two groups before and after surgery.Results 1.There were nosignificant differences in age,body mass index,and blood pressure between the two groups(P>0.05).2.Conventional color ultrasonography of plaque in both groups: there was no statistically significant difference in plaque length and thickness,and the difference in plaque echo type and ulcer plaque was statistically significant(P<0.05).3.The semi-quantitative visual grading composition of plaques in the two groups was different,and the difference was statistically significant(P=0.038),the number of scored 2,3 plaques in the symptomatic group was higher than that in the asymptomatic group.4.Quantitative evaluation of plaque angiography in the two groups: the PT value of the plaque group was smaller than that of the asymptomatic group,and the PI,BI,and EI values were larger than the asymptomatic group,the difference was statistically significant(P<0.05).5.Plaque shear wave elastography:MaxYM,MinYM,and MeanYM values in the symptomatic group were small overall,the difference was statistically significant(P<0.05).6.The plaque classification of pathological diagnosis of CEA in the two groups was different,the difference was statistically significant(P=0.036).The number of unstable plaques of type IV,V and VI in the symptomatic group was significantly higher than that in the asymptomatic group.7.The blood flow of the internal carotid artery and middle cerebral artery in the same group was significantly different before and after operation.The difference was statistically significant(P<0.05).The blood flow of the internal carotid artery and middle cerebral artery was stable at 1 week,1 month and 3months after operation,and the difference was not statistically significant(P>0.05).Conclusions(1)Patients with symptomatic group had less plaque stability than patients in the asymptomatic group.(2)Multimodal ultrasound examination combined with the evaluation of plaque stability is closely related to postoperative pathological results,providing important information for plaque stability assessment.(3)Carotid endarterectomy can perform good revascularization in patients with or without cerebral ischemia.The blood flow of the brain and carotid artery recovered well after surgery.