颈动脉超声斑块回声特征与颈动脉支架植入术围术期缺血性卒中相关性分析  

Correlation between echogenicity of carotid artery plaques and perioperative ischemic stroke after carotid artery stent implantation

作　　者：梁紫轲 唐小斌[1] 何楠[1] 张腾飞[1] 王晓娜[1] 刘博文[1] 陈忠[1] Liang Zike;Tang Xiaobin;He Nan;Zhang Tengfei;Wang Xiaona;Liu Bowen;Chen Zhong(Vascular Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院血管外科中心,北京100029

出　　处：《中华血管外科杂志》2022年第3期182-186,共5页Chinese Journal of Vascular Surgery

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2018R0004)。

摘　　要：目的探究多普勒超声斑块回声特征与颈动脉支架植入术(CAS)围术期缺血性卒中的相关性。方法回顾性分析2017年1月至2020年8月在北京安贞医院血管外科行CAS的316例颈动脉狭窄患者的临床资料,根据颈动脉彩色多普勒超声结果,将患者分为低回声斑块组(n=50)、混合回声斑块组(n=79)和强回声斑块组(n=187)。比较三组的基本资料和围术期并发症情况,采用Logistic回归分析CAS围术期脑梗死的危险因素。结果低回声斑块组、混合回声斑块组和强回声斑块组患者在年龄、性别、吸烟饮酒情况、合并疾病、双侧病变、手术左右侧、支架类型和后扩张情况方面差异均无统计学意义(均P>0.05),三组合并症状性颈动脉狭窄情况的差异具有统计学意义(56.0%比39.2%比29.4%,χ^(2)=12.551,P=0.002);三组患者围术期死亡、心肌梗死、急性肾衰竭和支架并发症情况差异均无统计学意义(均P>0.05);三组CAS围术期脑梗死发生率分别为10.0%(5/50)、3.8%(3/79)和1.1%(2/187),三组差异有统计学意义(χ^(2)=10.405,P=0.006),其中低回声斑块组与强回声斑块组围术期脑梗死发生率差异有统计学意义(P=0.005)。多因素Logistic回归分析显示,低回声斑块是CAS围术期脑梗死发生的独立危险因素(OR=12.566,95%CI:2.078~75.971,P=0.006)。结论症状性颈动脉狭窄患者多合并低回声斑块,颈动脉超声提示低回声斑块的患者行CAS围术期脑梗死发生率较高,同时低回声斑块是CAS围术期脑梗死的独立危险因素。Objective To investigate the correlation between Doppler plaque echogenicity and perioperative ischemic stroke after carotid artery stenting(CAS).Methods Clinical data of 316 patients with carotid artery stenosis who underwent CAS in the Department of Vascular Surgery of Beijing Anzhen Hospital from January 2017 to August 2020 were retrospectively analyzed.According to the results of carotid color Doppler ultrasound,the patients were divided into hypoechoic plaque group(n=50),mixed echo plaque group(n=79),and hyperechoic plaque group(n=187).Baseline data and perioperative complications were compared among the three groups.Risk factors for perioperative cerebral infarction were studied by multivariate Logistic regression analysis.Results There were no statistically significant differences in age,gender,smoking and drinking status,complicating disease,bilateral lesions,left or right side of surgery,stent type and dilation among the three groups(all P>0.05),but there were statistically significant differences in symptomatic carotid artery stenosis among the three groups(56.0%vs 39.2%vs 29.4%,χ^(2)=12.551,P=0.002).There were no statistically significant differences in perioperative death,myocardial infarction,acute renal failure and stent complications among the three groups(all P>0.05).The incidence of perioperative cerebral infarction was 10.0%(5/50)in the hypoechoic plaque group,3.8%(3/79)in the mixed echo plaque group and 1.1%(2/187)in the hyperechoic echo plaque group,and there was a statistically significant difference(χ^(2)=10.405,P=0.006).Difference in the incidence of perioperative cerebral infarction between the hypoechoic plaque group and the hyperechoic plaque group had statistical significance(P=0.005).Multivariate Logistic regression analysis showed that hypoechoic plaque was an independent risk factor for perioperative cerebral infarction after CAS(OR=12.566,95%CI:2.078~75.971,P=0.006).Conclusion Patients with symptomatic carotid artery stenosis are mostly complicated by hypoechoic plaque.Carotid ult

关 键 词：斑块回声 颈动脉支架植入术 缺血性卒中 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R651.12[医药卫生—诊断学]