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Objective@#To investigate the correlation between carotid plaque vulnerability and MRI imaging markers and overall burden of cerebral small vessel disease (CSVD).@*Methods@#From January 2018 to December 2018, patients with carotid plaque thickness ≥2 mm admitted to the Brain Disease Center, the Affiliated Hospital of Nanjing University of Chinese Medicine was enrolled prospectively. Contrast-enhanced ultrasonography (CEUS) was used to evaluate the vulnerability of carotid plaque. All patients underwent head MRI. Lacunar infarction, white matter hyperintensities, cerebral microbleeds and enlarged perivascular space were recorded and the overall burden of CSDV was calculated. Binary multivariate logistic regression analysis was used to determine the correlation between carotid vulnerable plaque and various imaging markers of CSVD. Ordinal multivariable logistic regression analysis was used to determine the correlation between the carotid vulnerable plaques and the overall burden of CSCD.@*Results@#A total of 112 patients were included, including 61 (54.5%) in vulnerable plaque group and 51 (45.5%) in non-vulnerable plaque group. There were significant differences in the proportion of diabetes mellitus (49.2% vs. 19.6%; χ2=10.580, P<0.001), lacunar infarction (54.1% vs. 31.4%; χ2=5.829, P=0.016) and white matter hyperintensities (41.0% vs. 19.6%; χ2=5.907, P=0.015) between the vulnerable plaque group and the non-vulnerable plaque group. Multivariate logistic regression analysis showed that after adjusting for age, gender, hypertension, diabetes, and hyperlipidemia, there was a significant independent correlation between lacunar infarction (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.139-6.765; P=0.025) and white matter hyperintensities (OR 3.969, 95% CI 1.465-10.753; P=0.007) and carotid vulnerable plaque. There were significant differences in age (F=4.275, P=0.003), past stroke history (χ2=11.100, P=0.025) and vulnerable plaque (χ2=9.829, P=0.043) in different CSVD burden groups. The overall burden of CSVD increased significantly with the increase of CEUS grade of carotid plaque (χ2=28.525, P=0.005). Ordinal multivariable logistic regression analysis showed that after adjusting for age, gender, hypertension, diabetes, coronary heart disease, stroke history, and smoking, there was still a significant independent correlation between the overall burden of CSVD and vulnerable plaques (OR 3.753, 95% CI 1.678-8.392; P=0.001).@*Conclusions@#Carotid vulnerable plaques were independently associated with lacunar infarction, white matter hyperintensities, and total burden of CSVD.
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Objective To investigate the correlation between carotid plaque vulnerability and MRI imaging markers and overall burden of cerebral small vessel disease (CSVD).Methods From January 2018 to December 2018,patients with carotid plaque thickness ≥2 mm admitted to the Brain Disease Center,the Affiliated Hospital of Nanjing University of Chinese Medicine was enrolled prospectively.Contrast-enhanced ultrasonography (CEUS) was used to evaluate the vulnerability of carotid plaque.All patients underwent head MRI.Lacunar infarction,white matter hyperintensities,cerebral microbleeds and enlarged perivascular space were recorded and the overall burden of CSDV was calculated.Binary multivariate logistic regression analysis was used to determine the correlation between carotid vulnerable plaque and various imaging markers of CSVD.Ordinal multivariable logistic regression analysis was used to determine the correlation between the carotid vulnerable plaques and the overall burden of CSCD.Results A total of 112 patients were included,including 6l (54.5％) in vulnerable plaque group and 51 (45.5％) in non-vulnerable plaque group.There were significant differences in the proportion of diabetes mellitus (49.2％ vs.19.6％;x2 =10.580,P ＜ 0.001),lacunar infarction (54.1％ vs.31.4％;x2 =5.829,P =0.016) and white matter hyperintensities (41.0％ vs.19.6％;x2 =5.907,P=0.015) between the vulnerable plaque group and the non-vulnerable plaque group.Multivariate logistic regression analysis showed that after adjusting for age,gender,hypertension,diabetes,and hyperlipidemia,there was a significant independent correlation between lacunar infarction (odds ratio [OR] 2.776,95％ confidence interval [CI] 1.139-6.765;P =0.025) and white matter hyperintensities (OR 3.969,95％ CI 1.465-10.753;P =0.007) and carotid vulnerable plaque.There were significant differences in age (F =4.275,P =0.003),past stroke history (x2 =11.100,P =0.025) and vulnerable plaque (x2 =9.829,P=0.043) in different CSVD burden groups.The overall burden of CSVD increased significantly with the increase of CEUS grade of carotid plaque (x2 =28.525,P =0.005).Ordinal multivariable logistic regression analysis showed that after adjusting for age,gender,hypertension,diabetes,coronary heart disease,stroke history,and smoking,there was still a significant independent correlation between the overall burden of CSVD and vulnerable plaques (OR 3.753,95％ CI 1.678-8.392;P =0.001).Conclusions Carotid vulnerable plaques were independently associated with lacunar infarction,white matter hyperintensities,and total burden of CSVD.
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Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.