Relationship between atherosclerotic plaque characteristics and clinical symptoms in patients with unilateral moderate-to-severe stenosis of extracranial internal carotid artery / 中风与神经疾病杂志

ABSTRACT

@#Objective To investigate the relationship between atherosclerotic plaque characteristics and clinical symptoms in patients with unilateral moderate-to-severe stenosis of the extracranial segment of the internal carotid artery. Methods We included a total of 151 patients who underwent carotid endarterectomy for unilateral moderate-to-severe carotid stenosis [confirmed by carotid Doppler ultrasonography(CDU) and computed tomography angiography] at the Department of Neurosurgery of the First Affiliated Hospital of Soochow University. They were divided into symptomatic group and asymptomatic group according to clinical manifestations. The two groups were examined by CDU for the characteristics of carotid artery plaques(fibrous cap integrity,ulcerative plaques,plaque calcification,etc.) and the degree of vascular stenosis. Transcranial Doppler ultrasonography was performed to record the hemodynamic parameters(Vm,Vs,Vd,and PI) of bilateral middle cerebral arteries(MCA). Computed tomography perfusion imaging(CTP) was performed to record the parameters(CBF,CBV,MTT,and TTP) of bilateral basal ganglia and temporal lobes. The two groups were compared for carotid plaque characteristics and the degree of stenosis using the chi-square test,and for the differences in the hemodynamic parameters of MCA between the unaffected and affected sides and the CTP parameters of the basal ganglia and temporal lobe on the affected side using the independent samples t test and the Mann-Whitney U test. Results The symptomatic group was significantly older at the age of onset than the asymptomatic group(P<0.05). The incidence rates of ulcerative plaques and plaque surface calcification were significantly higher in the symptomatic patients with moderate/severe carotid stenosis than in the asymptomatic groups(P<0.05). The differences in Vm,Vs,and Vd of MCA between the unaffected and affected sides were significantly larger in the symptomatic moderate/severe stenosis groups than in the asymptomatic moderate/severe stenosis groups(P<0.05). There were significant differences in CBF,MTT,and TTP of the basal ganglia and temporal lobe on the affected side between severe stenosis groups(P<0.05),but those CTP parameters showed no significant differences between moderate stenosis groups(P>0.05). Conclusion Severe carotid artery stenosis can cause intracranial hypoperfusion,and moderate stenosis with unstable plaques can also produce clinical symptoms. It is of great clinical significance to evaluate carotid plaque characteristics and the degree of stenosis for individualized diagnosis and treatment.