ABSTRACT
Objective To investigate the predictive value of carotid remodeling index (CRI), plaque characteristics, and hemodynamic changes in patients with severe carotid atherosclerotic stenosis. Methods A total of 185 continuous patients with unilateral severe carotid artery atherosclerotic stenosis who underwent surgical treatment were enrolled retrospectively in the Department of Neurosurgery and Vascular Surgery of Xuanwu Hospital, Capital Medical University from January 2016 to January 2019. According to the clinical symptoms, patients were divided into the symptom group ( 104cases) and the asymptomatic group (81 cases). The general clinical data, CRI, echo characteristics of plaque, and hemodynamic parameters were compared between the two groups. Multivariate logistic regression analysis was performed after excluding the collinearity of parameters. The value of CRI for predicting clinical ischemic events was analyzed through the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results (1) There were no significant differences in age and risk factors of cerebrovascular disease between the two groups (all P >0. 05). However, the rate of male patients was significantly higher in the symptom group compared with the asymptomatic group (92. 3% [96/104] vs. 80. 2% [65/81) , P < 0.05). (2)There were lower in the peak systolic velocity( PSV) of the distal internal carotid artery (50.0[28.3, 62.8] cm/s vs. 60. 0[44.5, 74.5] cm/s, P<0.01), the end-diastolic velocity (EDV) of the distal internal carotid artery(23.0[14.0, 30.0] cm/s vs. 29. 0[21. 5 , 33. 5 ] cm/s, P<0.01), the PSV of the ipsilateral middle cerebral artery ( [74 ±21 ] cm/s vs. [ 85±21]cm/s, P<0.01) , and the EDV of the ipsilateral middle cerebral artery([39 ±11] cm/s vs. [42 ± 10] cm/s, P <0.05) in the symptom group compared with the asymptomatic group. There were higher in the ratio of PSV at the stenosis lesion of the internal carotid artery to the distal internal carotid artery( PSVprox/PSVdist, 10. 3[6.1, 16.6]ta.7.2[5.0, 11.8]), CRI ( 1. 82 [ 1. 65, 2. 08] is. 1. 64 [ 1. 51, 1.80]), hypoechoic plaques (83.7% [ 87/104 ] vs. 37. 0% [ 30/81 ]) , and ulcerative plaques (27. 9% [ 29/104 ] vs. 7. 4% [6/81]) in the symptom group compared with the asymptomatic group (all P <0. 05). (3) Multivariate logistic regression analysis showed that CRI ( OR = 12. 43, 95% CI 2. 85 -54. 25 , P < 0. 01) , ulcerative plaque (Oft =4. 04, 95% CI 1.40-11.62, P<0.05), and hypoechoic plaque( OR =5. 54, 95% C/2.65-11.58, P<0.01) were independent risk factors for ischemic clinical events. (4)The best cutoff value of CRI was 1.74 for predicting ischemic clinical events in severe carotid artery atherosclerotic stenosis ( AUC = 0.714,95% C/0.64-0.79, P<0.05), with the specificity of 69. 1% , and sensitivity of 65. 4% . Conclusions CRI, ulcerative plaques, and hypoechoic plaques can increase the risk of clinical ischemic events in patients with severe carotid atherosclerotic stenosis. CRI can be used to predict clinical ischemic events in patients with severe carotid stenosis.
ABSTRACT
Objective To study the efficacy and safety of carotid endarterectomy ( CEA) in the treatment of carotid artery stenosis with different neurological deficits .Methods The clinical data of 59 patients with carotid stenosis treated by carotid endarterectomy in the department of neurosurgery of affiliated hospital of Xuzhou medical university from September 2015 to February 2017 were analyzed retrospectively ,a total of 62 operations were performed in these patients ( including 3 patients accepted bilateral operation ) .According to the preoperative 1 day nerve function which evaluated by the modified Rankin scale (mRS)score,they were divided into mRS <3 group(n=47),mRS≥3 group (n=15).They were followed up for 6 to 24 months,the neurological function of 62 patients was scored again by mRS at 6 months after sur-gery.The clinical data and the difference of surgical efficacy and safety of perioperative period between the 2 groups were analyzed and com-pared.Results The 62 times of operations were successful in patients .The neurological function of the 2 groups were significantly improved compared with the preoperative,the difference was statistically significant(P<0.05).In the mRS≥3 group,there were 1 patients with perio-perative cerebral infarction died of cerebral hernia ,1 case of consciousness disorder caused by high perfusion and 1 cases of postoperative in-tracranial hemorrhage caused by high perfusion .In the mRS<3 group,there was 1 case left contralateral hemiplegia caused by a large area of cerebral infarction .The incidence of cerebral apoplexy within 30 days after procedure in the mRS≥3 group was significantly higher than that in the mRS<3 group.There was no new stroke in 61 patients during the long-term follow-up.Conclusion Mild(mRS<3) and severe(mRS≥3) of patients has improved nervous function from CEA;perioperative risk of patients with severe neurological deficits is relatively higher , but the preventive effect for the prevention of ischemic stroke recurrence is worthwhile .
ABSTRACT
To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)