| Objective: To investigate the clinical value of contrast-enhanced ultrasound(CEUS)in the plaque assessment of patients with carotid artery stenosis and in carotid artery stenting(CAS).Methods: From 1 January 2020 to 31 December 2020,patients with carotid artery stenosis were hospitalized for CAS in the Department of Neurology and Neurological Intervention,Affiliated Hospital of Qingdao University.All patients were performed by conventional ultrasound and CEUS within 1 week before CAS,recording the echogenicity,degree of stenosis of carotid artery plaque and intra-plaque neovascularization(IPN),which was analyzing the assessment value of plaque vulnerability before CAS compared CEUS with conventional ultrasound.AS 1 year after CAS as the end point,all patients were followed up by CEUS at 3 and 12 months.Recording the incidence of in-stent restenosis(ISR)during the follow-up and analyzing the relationship between IPN and ISR after CAS.Results: According to the inclusion and exclusion criteria,there were 126 patients included,with 102 males and 24 females,aged from 37 to 83 years,average age was 66.70±7.76 years.1、Assessment of carotid artery plaques by CEUS and conventional ultrasound before CAS: According to the enhancement of CEUS,IPN was divided into3 grades.Preoperative results showed that: there were 61 cases in Grade0,49 cases in Grade1 and 16 cases in Grade2.(1)The relationship between plaque echo property with conventional ultrasound and IPN by CEUS: There were 18 homogeneous hypoechoic plaques with conventional ultrasound,of which 16.67% were Grade0,50.00% were Grade1 and 33.33% were Grade2;there were 21 heterogeneous hypoechoic plaques,33.33% were Grade0,42.86% were Grade1 and 23.81% were Grade2.There were 59 heterogeneous hyperechoic plaques,57.63% wereGrade0,33.90% were Grade1 and 8.47% were Grade2;and 28 homogeneous hyperechoic plaques,60.72% of which were Grade0,39.28% were Grade1 and no Grade 2.There was a significant difference between carotid plaque echo and the IPN grades(χ2=17.645,P<0.001),which was a moderate negative correlation(R=-0.376,P<0.001).The lower the echo of the plaque detected by conventional ultrasound,the richer the IPN by CEUS.(2)The relationship between the degree of carotid stenosis measured by conventional ultrasound and IPN assessed by CEUS: There were 2 mild stenosis(<50%)with conventional ultrasound,of which 50.00% were Grade0,50.00%were Grade1 and no Grade2;28 moderate stenosis(50-69%),of which 39.29%were Grade0,46.43% were Grade1 and 14.28% were Grade2;96 severe stenosis(70~99%),of which 51.04%were Grade0,36.46% were Grade1 and 12.50% were Grade2,and there was no carotid artery occlusion.There was no significant difference between the degree of carotid stenosis and IPN grades(χ2=0.434,P=0.510),which was no significant correlation(R=-0.059,P=0.512).(3)Comparison of CEUS and conventional ultrasound in the diagnosis of carotid stenosis: Digital subtraction angiography(DSA)is the diagnosis standard of carotid artery stenosis.CEUS had good consistency with conventional ultrasound in detection of carotid stenosis comparing with DSA(CEUS: Kappa=0.845;conventional ultrasound: Kappa=0.782).The sensitivity and specificity of CEUS in the diagnosis of severe carotid artery stenosis were higher than those of conventional ultrasound(The sensitivity of CEUS was 96.88%,95%CI:0.905~0.992,the specificity was 83.33%,95%CI:0.645~0.937;The sensitivity of conventional ultrasound was 96.81%,95% CI: 0.903 ~ 0.992,the specificity was 78.13%,95% CI: 0.596 ~ 0.901).2、Analysis of the relationship between IPN evaluated by CEUS before CAS and visible tissue fragments from the intraoperative umbrella: During the CAS,74 weren’t found tissue fragments,of which 58.11% were Grade0,36.49% were Grade1 and 5.40% were Grade2 evaluated by CEUS.52 found tissue fragments,of which 34.62% were Grade0,42.30% were Grade1 and 23.08% were Grade2.The IPN grades were related to the tissue fragments,and there was a slight positive correlation(R = 0.291,P = 0.001).Richer IPN assessed by CEUS before CAS,higher possibility of detecting the visible tissue fragments in the umbrella.3、ISR was followed up by CEUS: 85 were followed up finally.A total of 11 had ISR after CAS,and the restenosis rate was 12.94%,of which 27.27% were Grade1 and 72.73% were Grade2,no Grade0.Therewere 74 without ISR,of which 37.84% were Grade0,44.59% were Grade1 and 17.57% were Grade2.The richer IPN assessed by CEUS,the higher the risk of ISR after CAS.Logistic regression analysis suggested the IPN grades(Grade2)were the risk factor for ISR(OR=12.513,95%CI :2.918~53.650,P=0.001),it was also found that using closed cell stent was the risk factor for ISR(closed cell stent OR=4.773,95%CI :1.239~18.385,P=0.023).Conclusion: 1、CEUS can evaluate the plaque stability of carotid stenosis effectively.Compared with conventional ultrasound,CEUS can more accurately reflect the stability of plaque and the degree of carotid artery stenosis.2、CEUS can be used for postoperative monitoring of CAS.The IPN assessed by CEUS is an independent risk factor for ISR.3、CEUS is a simple,noninvasive procedure that can be used to guide the preoperative plaque evaluation,the choice of interventional therapy and the postoperative follow-up of carotid artery stenosis.CEUS is worthy of clinical application. |
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