目的探索同侧非狭窄性颈动脉粥样硬化斑块特征与前循环不明原因栓塞性卒中(embolic stroke of undetermined source,ESUS)的相关性。方法回顾性纳入北京市大兴区人民医院神经内科2017年1月-2022年5月连续住院的急性单侧前循环缺血性ESU...目的探索同侧非狭窄性颈动脉粥样硬化斑块特征与前循环不明原因栓塞性卒中(embolic stroke of undetermined source,ESUS)的相关性。方法回顾性纳入北京市大兴区人民医院神经内科2017年1月-2022年5月连续住院的急性单侧前循环缺血性ESUS患者。采用颈动脉超声评估双侧非狭窄性颈动脉粥样硬化斑块,比较梗死同侧颈动脉与对侧颈动脉斑块的发生率、多发斑块的发生率、不均质回声斑块的比例以及颈动脉斑块厚度等特征的差异。结果共纳入101例ESUS患者,平均年龄60.7±14.1岁,男性72例(71.3%)。梗死同侧非狭窄性颈动脉粥样硬化斑块发生率为66.3%(67/101),梗死对侧颈动脉斑块发生率为55.4%(56/101),差异有统计学意义(P=0.028);梗死同侧颈动脉多发斑块发生率为41.6%(42/101),梗死对侧多发斑块发生率为31.7%(32/101),差异有统计学意义(P=0.019);梗死同侧不均质回声斑块的发生率高于梗死对侧颈动脉(39.6%vs.23.8%,P<0.001)。另外,梗死同侧颈动脉斑块平均厚度大于梗死对侧颈动脉(2.8 mm vs.2.1 mm,P<0.001)。结论本研究急性ESUS患者中,梗死灶同侧的颈动脉较对侧颈动脉更易出现动脉粥样硬化斑块,且多发斑块、斑块不稳定的比例也更高,斑块平均厚度更大,提示ESUS的发生与非狭窄性颈动脉斑块超声特征有一定的相关性。展开更多
目的:借助人工智能(Artificial Intelligence, AI)评估单侧前循环梗死患者计算机断层血管造影(Computed Tomography Angiography, CTA)非颈动脉斑块的特征与来源不明的栓塞性卒中(Embolic Stroke of Undetermined Source, ESUS)之间的...目的:借助人工智能(Artificial Intelligence, AI)评估单侧前循环梗死患者计算机断层血管造影(Computed Tomography Angiography, CTA)非颈动脉斑块的特征与来源不明的栓塞性卒中(Embolic Stroke of Undetermined Source, ESUS)之间的关联。方法:确定2022年5月至2024年3月入院的急性单侧前循环缺血性脑卒中患者,纳入大动脉粥样硬化(Large Artery Atherosclerosis Stroke, LAAS)、ESUS、心源性栓塞(Cardioembolic Stroke, CES)患者,比较ESUS与LAAS及CES患者的临床特征,并基于CTA影像的AI自动分析比较ESUS患者缺血事件同侧及对侧颈动脉斑块特征的差异并探求其关联。结果:我们对72例LAAS患者、50例ESUS患者及30例CES患者进行分析,发现ESUS与LAAS患者相较发病年龄更小、C反应蛋白水平更低。ESUS与CES患者相较合并更多的血管危险因素和更少的异常心脏指标。在影像学方面,ESUS患者缺血事件同侧颈动脉混合或非钙化斑块数量多于对侧,管腔狭窄处混合或非钙化斑块的发生率更高;Logistic回归分析显示两者均为ESUS的独立影响因素。比较LAAS与ESUS缺血事件侧颈动脉斑块特征发现,LAAS颈动脉混合或非钙化斑块更加普遍。结论:ESUS的临床危险因素更接近LAAS而不是CES,混合或非钙化斑块在缺血事件同侧更常见,可能为ESUS的潜在病因标志。Objective: To evaluate the association between characteristics of non-carotid plaque and embolic stroke of undetermined source (ESUS) on computed tomography angiography (CTA) in patients with unilateral anterior circulation infarction with artificial intelligence (AI). Methods: Patients with acute unilateral anterior circulation ischemic stroke admitted to the hospital from May 2022 to March 2024 were identified and included as large artery atherosclerosis stroke (LAAS), ESUS, and cardioembolic stroke (CES). The clinical features of ESUS, LAAS, and CES patients were compared and AI-based on CTA images automatically analyzed and compared the differences in ipsilateral and contralateral carotid plaque features of ESUS patients with ischemic events and explored their correlation. Results: We analyzed 72 patients with LAAS, 50 patients with ESUS, and 30 patients with CES and found that ESUS patients had younger onset age and lower C-reactive protein levels than LAAS patients. ESUS patients had more vascular risk factors and fewer abnormal cardiac markers than CES patients. In terms of imaging, ESUS patients had more mixed or non-calcified plaques in the ipsilateral carotid artery than the contralateral carotid artery, and the incidence of mixed or non-calcified plaques in lumen stenosis was higher. Logistic regression analysis showed that both were independent influencing factors of ESUS. Comparing the features of carotid plaque on the side of LAAS and ESUS ischemic events, it was found that mixed or non-calcified carotid plaque of LAAS was more common. Conclusion: The clinical risk factors for ESUS are closer to LAAS than CES, and mixed or non-calcified plaques are more common on the same side of ischemic events, which may be a potential etiological marker for ESUS.展开更多
文摘目的探索同侧非狭窄性颈动脉粥样硬化斑块特征与前循环不明原因栓塞性卒中(embolic stroke of undetermined source,ESUS)的相关性。方法回顾性纳入北京市大兴区人民医院神经内科2017年1月-2022年5月连续住院的急性单侧前循环缺血性ESUS患者。采用颈动脉超声评估双侧非狭窄性颈动脉粥样硬化斑块,比较梗死同侧颈动脉与对侧颈动脉斑块的发生率、多发斑块的发生率、不均质回声斑块的比例以及颈动脉斑块厚度等特征的差异。结果共纳入101例ESUS患者,平均年龄60.7±14.1岁,男性72例(71.3%)。梗死同侧非狭窄性颈动脉粥样硬化斑块发生率为66.3%(67/101),梗死对侧颈动脉斑块发生率为55.4%(56/101),差异有统计学意义(P=0.028);梗死同侧颈动脉多发斑块发生率为41.6%(42/101),梗死对侧多发斑块发生率为31.7%(32/101),差异有统计学意义(P=0.019);梗死同侧不均质回声斑块的发生率高于梗死对侧颈动脉(39.6%vs.23.8%,P<0.001)。另外,梗死同侧颈动脉斑块平均厚度大于梗死对侧颈动脉(2.8 mm vs.2.1 mm,P<0.001)。结论本研究急性ESUS患者中,梗死灶同侧的颈动脉较对侧颈动脉更易出现动脉粥样硬化斑块,且多发斑块、斑块不稳定的比例也更高,斑块平均厚度更大,提示ESUS的发生与非狭窄性颈动脉斑块超声特征有一定的相关性。
文摘目的:借助人工智能(Artificial Intelligence, AI)评估单侧前循环梗死患者计算机断层血管造影(Computed Tomography Angiography, CTA)非颈动脉斑块的特征与来源不明的栓塞性卒中(Embolic Stroke of Undetermined Source, ESUS)之间的关联。方法:确定2022年5月至2024年3月入院的急性单侧前循环缺血性脑卒中患者,纳入大动脉粥样硬化(Large Artery Atherosclerosis Stroke, LAAS)、ESUS、心源性栓塞(Cardioembolic Stroke, CES)患者,比较ESUS与LAAS及CES患者的临床特征,并基于CTA影像的AI自动分析比较ESUS患者缺血事件同侧及对侧颈动脉斑块特征的差异并探求其关联。结果:我们对72例LAAS患者、50例ESUS患者及30例CES患者进行分析,发现ESUS与LAAS患者相较发病年龄更小、C反应蛋白水平更低。ESUS与CES患者相较合并更多的血管危险因素和更少的异常心脏指标。在影像学方面,ESUS患者缺血事件同侧颈动脉混合或非钙化斑块数量多于对侧,管腔狭窄处混合或非钙化斑块的发生率更高;Logistic回归分析显示两者均为ESUS的独立影响因素。比较LAAS与ESUS缺血事件侧颈动脉斑块特征发现,LAAS颈动脉混合或非钙化斑块更加普遍。结论:ESUS的临床危险因素更接近LAAS而不是CES,混合或非钙化斑块在缺血事件同侧更常见,可能为ESUS的潜在病因标志。Objective: To evaluate the association between characteristics of non-carotid plaque and embolic stroke of undetermined source (ESUS) on computed tomography angiography (CTA) in patients with unilateral anterior circulation infarction with artificial intelligence (AI). Methods: Patients with acute unilateral anterior circulation ischemic stroke admitted to the hospital from May 2022 to March 2024 were identified and included as large artery atherosclerosis stroke (LAAS), ESUS, and cardioembolic stroke (CES). The clinical features of ESUS, LAAS, and CES patients were compared and AI-based on CTA images automatically analyzed and compared the differences in ipsilateral and contralateral carotid plaque features of ESUS patients with ischemic events and explored their correlation. Results: We analyzed 72 patients with LAAS, 50 patients with ESUS, and 30 patients with CES and found that ESUS patients had younger onset age and lower C-reactive protein levels than LAAS patients. ESUS patients had more vascular risk factors and fewer abnormal cardiac markers than CES patients. In terms of imaging, ESUS patients had more mixed or non-calcified plaques in the ipsilateral carotid artery than the contralateral carotid artery, and the incidence of mixed or non-calcified plaques in lumen stenosis was higher. Logistic regression analysis showed that both were independent influencing factors of ESUS. Comparing the features of carotid plaque on the side of LAAS and ESUS ischemic events, it was found that mixed or non-calcified carotid plaque of LAAS was more common. Conclusion: The clinical risk factors for ESUS are closer to LAAS than CES, and mixed or non-calcified plaques are more common on the same side of ischemic events, which may be a potential etiological marker for ESUS.
