颈动脉粥样硬化斑块MRI血管壁成像特征与CAS围手术期血流动力学不稳定的关系  

Relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging and perioperative hemodynamic instability

作　　者：蒋超[1] 赵克强[1] 赵红亮 郑卓肇[2] 赵锡海[3] 吴巍巍[1] Jiang Chao;Zhao Keqiang;Zhao Hongliang;Zheng Zhuozhao;Zhao Xihai;Wu Weiwei(Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Radiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Center for Biomedical Imaging Research,Tsinghua University,Beijing 100084,China)

机构地区：[1]清华大学附属北京清华长庚医院血管外科,清华大学临床医学院,北京102218 [2]清华大学附属北京清华长庚医院放射科,清华大学临床医学院,北京102218 [3]清华大学生物医学工程系生物医学影像研究中心,北京100084

出　　处：《中华医学杂志》2023年第25期1918-1924,共7页National Medical Journal of China

摘　　要：目的分析中重度颈动脉狭窄患者的颈动脉粥样硬化斑块MRI血管壁成像特征与颈动脉支架植入术(CAS)围手术期血流动力学不稳定的关系。方法前瞻性纳入自2017年1月1日至2021年12月31日于清华大学附属北京清华长庚医院接受CAS治疗的颈动脉狭窄患者共89例,其中男74例,女15例,年龄43~87(67.8±8.2)岁。术前检查均完善颈动脉MRI血管壁成像,分析颈动脉斑块中是否存在大脂质核、斑块内出血和纤维帽破裂,将不存在上述危险因素的斑块定义为稳定斑块组(34例),反之为易损斑块组(55例),并计算每个斑块具有的危险因素数量。术中记录患者血压、心率的变化及术后多巴胺的使用情况。将斑块具有的危险因素作为自变量,临床结局作为因变量,计算RR值,并比较不同危险因素数量的患者上述临床结局的差异。结果易损斑块组术中血压下降、术中心率下降的发生率高于稳定斑块组[60.0%(33/55)比14.7%(5/34),38.2%(21/55)比14.7%(5/34);均P<0.05]。MRI血管壁成像特征中,大脂质核45例,对血压下降和心率下降的RR值分别为3.15(1.69~5.87)、2.20(1.07~4.53);斑块内出血37例,对血压下降和心率下降的RR值分别为2.70(1.61~4.55)、2.25(1.15~4.39);纤维帽破裂29例,对血压下降和心率下降的RR值分别为1.50(0.94~2.40)、1.29(0.67~2.49)。易损斑块的危险因素越多,术中血压下降和心率下降的发生率越高:危险因素为0~3个时,血压下降发生率分别为14.7%(5/34)、9/18、11/18、13/19(P<0.001),心率下降的发生率分别为14.7%(5/34)、6/18、7/18、8/19(P=0.022)。两组间术后使用多巴胺的患者比例差异无统计学意义(P>0.05)。结论颈动脉斑块MRI血管壁成像提示颈动脉易损斑块危险因素越多的患者在进行CAS时出现血压和心率下降的风险越高。Objective To analyze the relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging(MRI)and perioperative hemodynamic instability in patients with severe carotid artery stenosis undergoing carotid artery stenting(CAS).Methods A total of 89 patients with carotid artery stenosis who underwent CAS treatment at Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January 1,2017,to December 31,2021,were prospectively included.Among them,74 were male and 15 were female,with an age range of 43 to 87 years(mean age:67.8±8.2 years).Preoperative examinations included carotid artery MRI vessel wall imaging to analyze the existence of large lipid-rich necrotic core(LRNC),intraplaque hemorrhage(IPH),and fibrous cap rupture in carotid artery plaques.Plaques without the above-mentioned risk factors were defined as stable plaque group(34 cases),while those with such risk factors were defined as vulnerable plaque group(55 cases).The number of risk factors present in each plaque was also calculated.Intraoperative changes in blood pressure and heart rate were recorded,and the use of dopamine postoperatively was noted.Using the risk factors that the plaque has as independent variables and the clinical outcomes as dependent variables,the RR values were calculated,and the differences in clinical outcomes of patients with different risk factors were compared.Results The incidence rates of hypotension and bradycardia were higher in patients with vulnerable plaques than those with stable plaques(60.0%(33/55)vs 14.7%(5/34)and 38.2%(21/55)vs 14.7%(5/34),respectively;both P<0.05).Based on MRI imaging features,the large LRNC was present in 45 cases,with RR values for hypotension and bradycardia of 3.15(1.69-5.87)and 2.20(1.07-4.53),respectively;IPH was present in 37 cases,with RR values for hypotension and bradycardia of 2.70(1.61-4.55)and 2.25(1.15-4.39),respectively;and fibrous cap rupture was present in 29 cases,with RR values for hypotension and bradycardia of 1.50(0.94-2.40)a

关 键 词：动脉粥样硬化 放射学 颈动脉 斑块 磁共振成像 支架植入术 血流动力学不稳定 横断面研究 

分 类 号：R543.4[医药卫生—心血管疾病]