Predictive value of vascular structure and hemodynamic characteristics for clinical ischemic symptoms in patients with severe carotid atherosclerotic stenosis / 中国脑血管病杂志

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.