| Objective：In addition to the severity of carotid stenosis, the stability ofplaque is an important factor to predict ischemic cerebrovascular diseaseevents. Unstable plaques have been proved to be an independent predictor ofischemic cerebrovascular disease. We have evaluated the morphologicalcharacteristics of carotid atherosclerotic plaque and analyzed the frequency ofthe plaque ulceration with256-slice CT angiography. We made a furtheranalysis of the relationship between the atherosclerotic plaque surfacemorphology with severity of stenosis and symptomatology.Methods：256-slice CT angiography images from386patients wereevaluated. Plaque surface morphology was classified as smooth, irregular, orulcerated. All the patients were divided into four groups according to clinicalsymptoms，they are the amaurosis group (AmF), transient ischemic attackgrop(TIA), ischemic stroke group and asymptomatic group. The degree ofcarotid artery stenosis, the morphological characteristics of carotidatherosclerotic plaque on the Portal workstations with the application of MIP,VR, MPR, CPR, Advanced Vessel Analysis (advanced vessel analysis, AVA)and other post-processing software. This was completed by two associate chiefphysicians or archiaters with the application of blind method, who wereengaged in neurological diagnostic imaging for a long time. They reachedconsensus through discussion when their views are not uniform. We applySPSS13.0statistical analysis software to analyze the correlation between themorphological characteristics of plaque and carotid stenosis，different clinicalsymptoms.Results：1There are totally386patients including258cases of male and female 128cases,the age range form37to87years old with an average age of61.15years old.2We found274cases with carotid lesions in386patients. There were1544carotid arteries totally, carotid artery disease in658(42.61%), includingocclusion for34. Totally624carotid atherosclerotic plaques were found,including the smooth394(63.15%), irregular161(25.80%), and the plaqueulceration69(11.05%).3There were356patients with different degrees of cerebral ischemicsymptoms in all the386cases, including35cases of transient amaurosis,178cases of TIA and143cases of ischemic stroke. There were30cases of noobvious symptoms of cerebral ischemia.4In all cases, there were260patients with carotid artery disease anddifferert symptoms of cerebral ischemia,96cases only with carotid arterydisease but asymptoms. There is a statistical association between carotid arterydisease and cerebral ischemic symptoms (OR=3.095) by statistical analysis.5When the rate of carotid stenosis is greater than30%, the incidence ofplaque ulceration19.4%which was significantly higher than the grop ofcarotid stenosis less than30%(3.12%). There was significant statisticallydifference between the two grops (P＜0.05). When the rate of carotid stenosisis greater than70%, the incidence of plaque ulceration increased to31.66%.We made a further analysis of the incidence of plaque ulceration betweendifferent degrees of stenosis grops. And we found that there were significantdifferences between the groups except the degree of stenosis in the Class IIIand Class VI and the incidence of plaque ulceration was increased with theincrease of the degree of stenosis.6The incidence of of the grop cerebral infarction is13.06%, which washigher than the TIA group (10.26%), the AmF group (6.55%) andasymptomatic group (9.37%). we used the line×list chi-square test to checkthe incidence of plaque ulceration between different ischemic symptoms grops.we found that there was no significant difference between the groups.7There were20responsibility lesions of69ulcerated plaque and69of 555non-ulcer plaque. There were significant differences between the groupsby statistical analysis (P＜0.05). And we also found that plaque ulceration incarotid artery was statistically associated with cerebral infarction (OR=2.875).8There were99cases, which there were cerebral infarction lesions inintracranial but also with the presence of lesions in ipsilateral carotid artery(symptomatic carotid artery), accounted for69.2%(99/143) of all cerebralinfarction cases. The rate of plaque ulceration of symptomatic carotid arterywas22.47%which was greater than the contralateral carotid artery (16.88%).There was no statistically significant difference between the two grops (P＞0.05).Conclision：1256slice CTA has very high clinical value which can accuratelydetermine the degree of stenosis of the carotid artery, but also make anaccurate and comprehensive evaluation to the morphological characteristics ofcarotid atherosclerotic plaque．2The incidence of plaque ulceration was statistically difference indifferent grop of different carotid stenosis and it was increased gradually withthe increase of the degree of stenosis.3There was significant difference statistically between the incidence ofplaque ulceration and cerebral infarction, which indicates that the presenceof plaque ulceration is closely related to cerebral infarction.4256-slice CTA is rarely used to evaluate the morphologicalcharacteristics of carotid atherosclerotic plaque at home and abroad. Forclinicians, the information about plaque morphological characteristics ofpatients play a key role in choosing which treatment and prognosis. Therefore,we must not only make an accurate measure of the degree of stenosis of theartery, but also an accurate description of the morphological characteristics ofthe carotid plaque in the future clinical work. Especially when we are writingthe diagnositic report of carotid artery,we should make a description of theplaque ulceration. Because this can provid an reference for clinicians who would select the best treatment program and make an objective prognostic forpatients. |
PDF Full Text Request