| Objective: The aim of this study was to combine carotid ultrasonography with transcranial color-coded Doppler(TCCD)to analyze the characteristics of cerebral and cervical arteries ischemic lesions in high-risk population of stroke of hypertensive patients,and comprehensively analyze the effects of degree of the unilateral internal carotid artery initial segment stenosis,and degree of the unilateral vertebral artery initial segment stenosis,and anatomic variations of carotid arteries and vertebral arteries,and dissection of carotid arteries and vertebral arteries on cerebral arteries blood supply.Investigating the significance of screening for cerebral and cervical arteries ischemic lesions in high risk population of stroke of hypertensive patients by integrated assessment of brain-neck artery ultrasound,to help clinicians comprehensively and dynamically evaluate the structure and hemodynamic changes of brain and cervical arteries in this population,in order to intervene as soon as possible and reduce the prevalence,recurrence,disability and mortality of stroke in patients with hypertension.Methods:(1)A total of 106 hypertensive patients with high risk of stroke who were examined in the ultrasound imaging department of Peking University Shenzhen Hospital from August 2018 to December 2022 were collected as the high-risk group,75 males and 31 females,ranging from 40 to 88 years old,with an average age of(63.93±10.78)years old;according to the age and gender of the high-risk group,a propensity score matching was constructed,and106 hypertensive patients without high-risk of stroke who were examined in the ultrasound imaging department of Peking University Shenzhen Hospital during the same period were matched as the control group,74 males and 32 females,ranging in age from 42 to 85 years old,with an average age of(60.64±9.72)years old.Carotid ultrasound was used to observe the common carotid artery(CCA),extracranial segments of internal carotid artery(ICA),and external carotid artery(ECA),vertebral artery(VA),subclavian artery(SA)and innominate artery(INA)diameter,carotid artery intimal medial thickness(IMT),carotid atherosclerotic plaques(including plaque location,size,morphology,acoustic characteristics),carotid artery anatomic variation,vertebral artery anatomical variation,blood flow direction,blood flow filling state and hemodynamic parameters;TCCD was used to observe the middle cerebral artery(MCA),anterior cerebral artery(ACA),terminal internal carotid artery(TICA),posterior cerebral artery(PCA),ophthalmic artery(OA),carotid siphon(CS),V4 segment of vertebral artery,posterior inferior cerebellar artery(PICA),basilar artery(BA),posterior communicating artery(PCo A)and anterior communicating artery(ACo A)blood flow direction,blood flow filling state,hemodynamic parameters and the establishments of collateral circulation;the patients with initial segment of unilateral internal carotid artery stenosis in high-risk group were selected to analyze the changes of blood flow dynamics in the ipsilateral MCA;the patients with stenosis of the initial segment of vertebral artery in high-risk group were selected to analyze the hemodynamic changes the V4 segment of ipsilateral vertebral artery.(2)The control group was selected by propensity matching to balance the baseline confounding factors,therefore,univariate analysis was used to compare the differences of the above observation indicators between the high-risk group and the control group.The observed data were discrete variables and the chi-square test was used.Results:(1)The number of patients with hypertension level 3 in the high-risk group was more than that in the control group,and there was a significant difference,while the number of patients with hypertension level 1 was lower than that in the control group,and the difference was significant(two P values <0.001),there was no significant difference in the number of grade 2 hypertension cases between the two groups(P>0.05).(2)The number of carotid IMT thickening cases,plaque cases and plaque numbers in stroke high-risk group were more than those in control group,and the difference was statistically significant(P=0.002,P<0.001 and P<0.001).(3)The comparison of acoustic characteristics of patches between the two groups showed no significant difference in the number of hyperechoic plaques and isoechoic patches(P>0.05);the number of hypoechoic plaques and heterogeneous echoic plaques in high-risk group of stroke was more than that in control group,and the difference was statistically significant(P<0.001,P=0.021).(4)The comparison of plaque morphological characteristics between the two groups showed no significant difference in the number of regular and irregular plaques(P>0.05),the number of ulcerative plaques in the high-risk stroke group was more than that in the control group,and the difference was statistically significant(P=0.045).(5)The number of cases of carotid artery stenosis and occlusion in the high-risk group of stroke was more than that in the control group,and the difference was statistically significant(two P values<0.001).(6)Comparison of the degree of carotid artery stenosis between the two groups showed that the degree of carotid artery stenosis in the stroke high-risk group was more than that in the control group,and the difference was statistically significant(P<0.001).(7)When the stenosis rate of initial segment of unilateral internal carotid artery <50%,50% to 69% and 70% to 99%,there was no significant difference in peak systolic velocity(PSV)and resistance index(RI)of the ipsilateral middle cerebral artery in the high-risk group of stroke compared with the control group(P>0.05);when the initial segment of the unilateral internal carotid artery is occluded,the ipsilateral middle cerebral artery PSV of high-risk group of stroke was lower than that of control group,and the difference was statistically significant(P<0.001),there was no significant difference in RI between high-risk group of stroke and control group(P>0.05).(8)When the stenosis rate of initial segment of unilateral vertebral artery <50%,50% to 69%,there was no significant difference in PSV and RI in the V4 segment of the ipsilateral vertebral artery between the high-risk group of stroke and the control group,with no statistical significance(P>0.05);when the stenosis rate of the initial segment of unilateral vertebral artery was 70%to 99% and occluded,the PSV of the V4 segment of the ipsilateral vertebral artery in the highrisk group of stroke was lower than that in the control group,and the difference was statistically significant(P<0.001);there was no significant difference in basilar artery PSV and RI between the high-risk population of stroke with initial segment of unilateral vertebral artery stenosis and the control group(P>0.05).(9)The number of cases of subclavian artery stenosis and subclavian artery steal in high-risk group of stroke was more than that in control group,and the difference was statistically significant(P=0.002、P=0.024).(10)The number of cases of cerebral artery stenosis and occlusion in high-risk group of stroke was more than that in the control group,and the difference was statistically significant(two P values <0.001).(11)The stenosis degree of middle cerebral artery,the V4 segment of vertebral artery and basilar artery in high-risk group of stroke was more than that in control group,and the difference was statistically significant(P<0.001,P=0.008 and P<0.001).(12)The number of collateral circulation open cases of anterior communicating artery,posterior communicating artery and internal carotid artery-external carotid artery in high-risk group of stroke was more than that in control group,and the difference was statistically significant(P<0.001).(13)There was no significant difference in the number of anatomical variation cases of carotid artery and vertebral artery between the two groups(P>0.05).(14)There was no significant difference in the number of carotid artery and vertebral artery dissection between the two groups(P>0.05).Conclusion:(1)The number of carotid IMT thickening cases,plaque cases,plaque numbers,number of hypoechoic plaques and heterogeneous echoic plaques,number of ulcerative plaques,cerebral and cervical arteries stenosis cases,cerebral and cervical arteries stenosis degree,subclavian artery stealing blood cases and collateral circulation opening cases in hypertensive patients with high risk of stroke were more than those in hypertensive patients without high risk of stroke;the PSV of ipsilateral middle cerebral artery of high-risk stroke population in hypertensive patients with the initial segment of unilateral internal carotid artery occlusion was lower than that of non-high-risk stroke population in hypertensive patients with normal initial segment of internal carotid artery;the PSV of V4 segment of ipsilateral vertebral artery of high-risk stroke population in hypertensive patients with unilateral vertebral artery initial segment stenosis rate of 70% to 99% and occlusion was lower than that of non-stroke high-risk population in hypertensive patients with normal initial segment of vertebral artery,and all the above differences were significant and statistically significant.(2)Carotid artery ultrasound combined with TCCD technology can comprehensively evaluate the cerebral and cervical arteries in patients with hypertension at the same time,and accurately diagnose the offending vessels qualitatively,quantitatively and locationally,the two examinations that should have been performed were integrated and complementary,which reduced missed diagnosis and misdiagnosis.(3)As a non-invasive,repeatable,real-time dynamic,easy to operate and no special contraindications,integrated assessment of brain-neck artery ultrasound can well evaluate the structure of brain and neck arteries,hemodynamic changes and collateral circulation opening in hypertensive patients,and provide objective basis for the formulation of stroke prevention and treatment programs,and is worthy of comprehensive promotion in the screening of stroke in hypertensive patients. |
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