Combining ultrasound with bio-indicators reveals progression of carotid stenosis

Mingjian Liu; Ziqian Zhang; Yan Zhao; Zhenghong Chen; Bin Chen; Yongxu Wei; Yijun Cheng; Lifeng Zhu; Dehua Chen; Derong Cui; Hanbing Shang

doi:10.21037/apm-21-2666

Combining ultrasound with bio-indicators reveals progression of carotid stenosis

Ann Palliat Med. 2021 Nov;10(11):11539-11547. doi: 10.21037/apm-21-2666.

Authors

Mingjian Liu¹, Ziqian Zhang², Yan Zhao³, Zhenghong Chen², Bin Chen⁴, Yongxu Wei², Yijun Cheng², Lifeng Zhu³, Dehua Chen⁵, Derong Cui⁶, Hanbing Shang²

Affiliations

¹ Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurosurgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Computer Net Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Department of Neurosurgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
⁵ School of Computer Science and Technology, Donghua University, Shanghai, China.
⁶ Department of Anesthesiology, Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

PMID: 34872279
DOI: 10.21037/apm-21-2666

Abstract

Background: Carotid artery stenosis (CAS) is one of the leading causes of ischemic stroke. However, knowledge of the changes in the plaque itself is lacking. Information about the ultrasound and clinical features of CAS will help elucidate the changes in prognostic and risk factors.

Methods: We evaluated 736 patients with carotid stenosis for an average 18-month follow-up. According to their degree of CAS stenosis, patients were allocated to one of three groups: regression (n=125), stable (n=443), or progression (n=168). An ordinal regression analysis was used to determine the risk factors for atherosclerosis progression. A logistic regression was subsequently applied to investigate the effects of CAS stenosis on cerebrovascular events after adjusting for various factors.

Results: The progression group had more male patients (P=0.02), hypoechoic plaque (P<0.01), high-risk high sensitivity C-reactive protein (hs-CRP) (P=0.02), ulcerative plaque (P=0.05), and hyperlipidemia (P=0.05) than the other two groups. There were no significant differences in residual ultrasound and clinical features among the three groups, including age, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), intima-media thickness (IMT), body mass index (BMI), diabetes mellitus (DM), hypertension (HTN), coronary heart disease (CHD), statin use, ulcerative plaque. The ordinal regression analysis identified hypoechoic plaque (OR, 1.53; 95% CI: 1.14-2.05; P<0.01) and high-risk hs-CRP (OR, 1.75; 95% CI: 1.17-2.61; P<0.01) as independent risk factors for CAS progression. Logistic regression analysis revealed that the stroke/transient ischemic attack adjusted odds ratio was 1.80 (95% CI: 1.03-3.13) in the progression group.

Conclusions: High-risk hs-CRP and hypoechoic plaque are independently associated with CAS progression. The progression of carotid stenosis is associated with a high risk of cerebrovascular events.

Keywords: High-sensitivity C-reactive protein (hs-CRP); carotid stenosis; plaque progression; stroke; ultrasound.

MeSH terms

Carotid Intima-Media Thickness
Carotid Stenosis* / diagnostic imaging
Humans
Male
Plaque, Atherosclerotic* / diagnostic imaging
Stroke* / diagnostic imaging
Ultrasonography