Correlation between Plaque Features and Downstream Perfusion in Symptomatic Middle Cerebral Artery Stenosis

doi:10.3969/j.issn.1673-5765.2021.05.003

Abstract

Abstract:

Objective To explore the relationship between plaque features and downstream perfusion in patients with severe middle cerebral artery stenosis. Methods This retrospective analysis enrolled consecutive patients with severe symptomatic unilateral middle cerebral artery stenosis who were admitted to the First Medical Center of Chinese PLA General Hospital from August 2013 to January 2016. The early-arriving blood flow proportion and late-arriving retrograde blood flow proportion were obtained by ASL perfusion imaging with a double post-labeling delay (PLD) of 1.5 s and 2.5 s, respectively, which represent antegrade and collateral blood flow. Meanwhile, the plaque features were obtained by high-resolution vessel wall imaging (HR VWI), including plaque enhancement, plaque area, plaque burden and remodeling index. The patients were divided into high and low burden groups according to whether the plaque burden was ≥50% or not. The relationship between plaque features and downstream perfusion was analyzed. Results A total of 58 patients were enrolled in this study, with the average age of 47.17±11.67 years and 39 males (67.2%). Plaque burden was negatively correlated with early-arriving blood flow proportion (r =-0.362, P =0.005), but not correlated with late-arriving retrograde blood flow proportion (r =-0.008, P =0.951). Compared with low burden group, the high burden group had elder age (50.38±11.33 vs 43.23±11.04, P =0.019), and the lower early-arriving blood flow proportion (72.13%±14.86% vs 83.00%±15.67%, P =0.009); multivariate regression analysis showed that the age (OR 1.056, 95%CI 1.000-1.115, P =0.050) and early-arriving blood flow proportion (per 1 quartile: OR 0.561, 95%CI 0.328-0.957, P =0.034) were independently related to the high burden of plaque. Conclusions Plaque burden is related to downstream antegrade blood flow perfusion. The higher the plaque burden is, the lower the antegrade blood flow proportion is, while the plaque is not obviously related to collateral blood flow.

Key words: Ischemic stroke; Middle cerebral artery; Plaque; Antegrade blood flow; Collateral blood flow

摘要：

目的探究大脑中动脉重度狭窄患者的斑块特征和下游血流灌注的关系。方法回顾性纳入2013年8月-2016年1月连续就诊于解放军总医院第一医学中心的症状性单侧大脑中动脉重度狭窄患者。采用ASL双标记后延迟时间（post-labeling delay，PLD）技术测量1.5 s和2.5 s的大脑中动脉供血区平均脑血流量，获取早达血流比例和迟至逆行血流比例，即前向和侧支血流。同时，采用高分辨率磁共振管壁成像（high-resolution vessel wall imaging，HR VWI）获取斑块特征，包括斑块强化、斑块面积、斑块负荷及重构指数。对斑块特征及下游血流灌注进行相关性分析，并依据斑块负荷是否≥50%将患者分为高负荷组和低负荷组进行组间比较和回归分析。结果共纳入58例患者，平均年龄47.17±11.67岁，男性39例（67.2%）。斑块负荷同早达血流比例呈负相关（r =-0.362，P =0.005），与迟至逆行血流比例无明显相关（r =-0.008，P =0.951）。与低负荷组相比，斑块高负荷组年龄更大（50.38±11.33岁 vs 43.23±11.04岁，P =0.019）、早达血流比例更低（72.13%±14.86% vs 83.00%±15.67%，P =0.009）；多因素回归分析显示，年龄（OR 1.056，95%CI 1.000～1.115，P =0.050）及早达血流比例（每增加1个四份位数：OR 0.561，95%CI 0.328～0.957， P =0.034）与斑块高负荷独立相关。结论斑块负荷与下游前向血流灌注有关，斑块负荷越高，前向血流比例越低，但与侧支血流无明显相关。

关键词: 缺血性卒中; 大脑中动脉; 斑块; 前向血流; 侧支血流

WEI Meng-Ting, LYU Jin-Hao, WANG Liu-Xian, ZHANG Sen-Hao, HAN Dong-Shan, WANG Xin-Rui,DUAN Cao-Hui, LOU Xin. Correlation between Plaque Features and Downstream Perfusion in Symptomatic Middle Cerebral Artery Stenosis[J]. Chinese Journal of Stroke, 2021, 16(05): 433-439.

魏梦婷，吕晋浩，王柳仙，张森皓，韩东山，王馨蕊，段曹辉，娄昕. 大脑中动脉狭窄斑块与灌注特征相关性分析[J]. 中国卒中杂志, 2021, 16(05): 433-439.

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