To Investigate The Value Of Super Micro-vascular Imaging In The Evaluation Of Carotid Artery Plaque Neovascularization

Objective:Ischemic stroke is the general name of brain tissue necrosis,duing to the stenosis or occlusion of the blood supply artery(the carotid and vertebral arte-ry)and the insufficiency of the cerebral blood supply.It has the characteristics of 5 high(high incidence,high recurrence rate,high disability rate and high ec onomic burden).With the economic growth,the improvement of people's living standard and the aging of population,the prevalence rate of obesity,hypertension and diabetes is increasing.So the incidence of cerebrovascular disease is increasin-g rapidly.It has been ranked the first cause of death among Chinese residents.At present,the number of new onset patients in China is 2 million 700thousand per year.The number of deaths per year is 1 million 650 thousand,and it is increasing.That is,on average,every 12s has one stroke,and one 21s per person died of stroke.In the face of such a severe stroke situation,in 2011,the state formally established the"Ministry of Health Stroke screening and prevention and Control Engineering Committee".The national distance Stroke Center(CTSC)was officially unveiled in May 18,2014.In April 7,2016,the"Beijing,Tianjin and Hebei integrated stroke emergency system"was launched in Beijing.The stroke has become one of the most popular public health problems,greatly damage caused huge economic losses to human health,to the society,so the risk of stroke in the family,an accurate assessment of clinical brain and timely diagnosis and treatment to reduce ischemic cerebrovascular disease morbidity and has a very important practical value.Atherosclerotic lesion of the cerebral blood supply artery(carotid and vertebral artery)is the main cause of the disease.Carotid plaque is the window of systemic atherosclerotic disease,which is closely related to the occurrence and development of cerebral infarction.In the past,we think that carotid atherosclerotic plaques cause severe stenosis of arterial lumens,which is the main reason for the occurrence of stroke caused by carotid plaques.The main mechanism of stroke caused by severe carotid artery stenosis is mainly the hypoperfusion of cerebral blood flow,the existence of arterial to arterial embolization and the synergistic effect of the two.With a series of deeper research and clinical practice found that the reduction of carotid atherosclerotic plaque in carotid artery stenosis secondary to distal blood flow,causing the occurrence of ischemic stroke rate is not high,resulting in the rupture of vulnerable plaques of thromboembolism,can cause stroke events.The neovascularization in the plaque plays a key role in the development of vulnerable plaque.At present,CEUS is used to observe the neovascularization in carotid plaques.It has been pointed out that there is a good correlation between ultrasound and semi quantitative examination of immune tissue.But this technique is a invasive examination,a relatively high cost,and a patient's physical condition.This paper through the study of micro flow imaging(SMI)andcontrast-enhancedultrasound(CEUS)detectionofplaque neovascularization is consistent with pathology,and verified,to further explore the differences in clinical symptoms or SMI grade,for better clinical treatment and provide a theoretical basis for stroke.Methods:Selected from February 2015 to February 2016,our hospital severe carotid artery stenosis undergoing carotid artery plaque stripping in 39 patients,record the gender and age of patients,clinical diagnosis and other basic information.The use of Toshiba Aplio500 ultrasonic diagnostic instrument(Toshiba,Tokyo,Japan),by two experienced doctor ultrasound were performed in blood flow imaging(SMI)and contrast-enhanced ultrasound(CEUS)examination,and classification of new vessels,check as much as possible to clearly show the interest in cutting surface and save the image after use,mobile hard disk image is derived.With the plaque intima stripping technology eversion carotid endarterectomy,carotid artery plaque tissue specimens from the patients were on the angiogenesis marker CD34 by immunohistochemistry.Using SPSS22.0 statistical software for statistical analysis of the above data,using Kappa test to explore whether the SMI and CEUS classification have better consistency,SMI classification analysis method to explore the detection of microvessel density differences in staining immunohistochemistry CD34 with single factor variance,correlation of SMI with clinical symptoms by Spearman method.Results:1.There are 39 patches of 39 patients,who have severe carotid artery stenosis undergoing carotid artery plaque stripping.After SMI examination,8cases were grade 0,6 were grade I and 25 were grade II.After CEUS examination,7 cases were grade 0,9 were grade I and 23 were grade II.SMI and CEUS consistent Kappa test results:Kappa=0.860>0,indicating that SMI and CEUS have good consistency in the detection of neovascularization in plaque.2.Included in 39 patients,39 plaques were performed after carotid endarterectomy.Immunohistochemicalfindingsshowedthatthe neovascularization density(x±s,mm~2)was 0:1.79±0.41,grade I:2.26±0.73,and grade II:3.11±0.48.One way ANOVA analysis showed that there was no significant difference between SMI0 level and grade I(P0-I=0.836>0.05)except for the level of P0-between group two and group I(P0-I=0.000<0.05,P0-II=0.041<0.05).Grade II was higher than grade I,and grade II was higher than grade II.3.Among the 39 cases,the clinical symptoms of 8 cases of asymptomatic patients(6 cases of grade SMI0,1 cases of SMI grade,1 cases of SMI grade II),transient ischemic attack(transient ischemia,attack,TIA)in 20 patients(2cases of grade SMI0,4 cases of grade SMI in 14 cases,SMI grade II),11stroke patients(0 cases of grade SMI0,1 cases of SMI grade,10 cases of SMI grade II).The Spearman rank correlation test rs=0.592>0 showed that there was a positive correlation between the clinical symptoms and the SMI classification.Conclusion:1SMI and CEUS have good consistency in the detection of neovascularization in carotid atherosclerotic plaques,which can provide a new method for clinical detection of neovascularization in carotid plaques.2Different SMI grades have different density of neovascularization,and the higher the level of SMI,the higher the density of neovascularization in pathological examination.3SMI classification can predict the risk of stroke to a certain extent.The higher the level of SMI,the greater the risk of cerebral apoplexy.