非狭窄性颈动脉斑块与前循环不明原因栓塞性卒中的相关性研究 Correlation of Non-Stenotic Carotid Plaque with Anterior Circulation Embolic Stroke of Undetermined Source

Abstract

目的 探索同侧非狭窄性颈动脉粥样硬化斑块特征与前循环不明原因栓塞性卒中（embolic stroke of undetermined source，ESUS）的相关性。 方法 回顾性纳入北京市大兴区人民医院神经内科2017年1月-2022年5月连续住院的急性单侧前循环缺血性ESUS患者。采用颈动脉超声评估双侧非狭窄性颈动脉粥样硬化斑块，比较梗死同侧颈动脉与对侧颈动脉斑块的发生率、多发斑块的发生率、不均质回声斑块的比例以及颈动脉斑块厚度等特征的差异。 结果 共纳入101例ESUS患者，平均年龄60.7±14.1岁，男性72例（71.3%）。梗死同侧非狭窄性颈动脉粥样硬化斑块发生率为66.3%（67/101），梗死对侧颈动脉斑块发生率为55.4%（56/101），差异有统计学意义（P=0.028）；梗死同侧颈动脉多发斑块发生率为41.6%（42/101），梗死对侧多发斑块发生率为31.7%（32/101），差异有统计学意义（P=0.019）；梗死同侧不均质回声斑块的发生率高于梗死对侧颈动脉（39.6% vs. 23.8%，P＜0.001）。另外，梗死同侧颈动脉斑块平均厚度大于梗死对侧颈动脉（2.8 mm vs. 2.1 mm，P＜0.001）。 结论 本研究急性ESUS患者中，梗死灶同侧的颈动脉较对侧颈动脉更易出现动脉粥样硬化斑块，且多发斑块、斑块不稳定的比例也更高，斑块平均厚度更大，提示ESUS的发生与非狭窄性颈动脉斑块超声特征有一定的相关性。 Abstract: Objective To investigate the correlation between anterior circulation embolic stroke of undetermined source (ESUS) and ipsilateral non-stenotic carotid plaque. Methods This retrospective study enrolled consecutive patients with anterior circulation ESUS at Department of Neurology of Beijing Daxing District People’s Hospital between January 2017 and May 2022. All the subjects underwent bilateral carotid ultrasonography, to evaluate non-stenotic carotid plaque number, thickness and echotexture. The incidence of non-stenotic carotid plaques, multiple plaques, the percentage of heterogeneous echo, and carotid plaque thickness were analyzed to evaluate the correlation of non-stenotic carotid plaque and anterior circulation ESUS. Results A total of 101 ESUS patients were included, with an average age of 60.7±14.1 years and 72 males (71.3%). The incidence of non-stenotic plaques in infarct ipsilateral carotid artery was higher than that in contralateral carotid artery (66.3% vs. 55.4%, P=0.028). The incidence of multiple non-stenotic plaques in infarct ipsilateral carotid artery was higher than that in contralateral carotid artery (41.6% vs. 31.7%, P=0.019). The percentage of patients with mixed-echo plaques in infarct ipsilateral carotid artery was higher than that in contralateral carotid artery (39.6% vs. 23.8%, P<0.001). The mean non-stenotic plaque thickness of infarct ipsilateral carotid artery was greater than that of contralateral carotid artery (2.8 mm vs. 2.1 mm, P<0.001). Conclusions For acute ESUS patients, infarct ipsilateral carotid artery was prone to have atherosclerotic plaques compared to contralateral carotid artery; and multiple plaques, vulnerable plaques were more common, and mean plaque thickness was greater, which suggested that ESUS may be correlated to non-stenotic carotid plaque.

Keywords

• 不明原因栓塞性卒中
• 非狭窄性颈动脉斑块
• 缺血性卒中
• embolic stroke of undetermined source
• non-stenotic carotid plaque
• ischemic stroke