术前超声斑块特征在评估颈动脉支架植入术后再狭窄风险中的价值

The value of preoperative ultrasound plaque characteristics in evaluating the risk of in-stent restenosis after carotid artery stent implantation

摘要:

目的 探讨术前超声斑块特征评估在颈动脉支架植入术（CAS）术后发生支架内再狭窄（ISR）中的价值。方法 采用回顾性分析方法，收集2022年6月—2024年9月海军军医大学第一附属医院200例实施CAS治疗的颈动脉狭窄患者的临床资料，根据CAS随访期间是否发生ISR，将入组患者分为ISR组（36例）与非ISR组（164例）。比较ISR组与非ISR组患者的临床资料及超声斑块特征。采用多因素一般Logistic回归模型分析CAS术后发生ISR的影响因素。绘制受试者工作特征（ROC）曲线分析狭窄处收缩期峰值流速（PSV）对CAS术后发生ISR的预测价值。结果 ISR组高血压患病率高于非ISR组（P <0.05）。ISR组斑块形状为不规则、回声性质为低回声、斑块内新生血管分级≥2级的构成比及狭窄处PSV均高于非ISR组（P <0.05）。多因素一般Logistic回归分析结果显示：合并高血压［O^R =2.034（95% CI：1.085，3.813）］、不规则斑块［O^R =1.698（95% CI：1.145，2.518）］、低回声斑块［O^R =1.625（95% CI：1.149，2.298）］、斑块内新生血管分级≥2级［O^R =2.231（95% CI：1.301，3.826）］、狭窄处PSV高［O^R =1.882（95% CI：1.254，2.825）］均为CAS术后发生ISR的危险因素（P <0.05）。ROC曲线分析结果显示，狭窄处PSV预测CAS术后发生ISR的敏感性为72.21%（95% CI：0.592，0.824），特异性为75.62%（95% CI：0.641，0.899），曲线下面积为0.788（95% CI：0.707，0.868）。结论 高血压、不规则斑块、低回声斑块、新生血管丰富及狭窄处PSV升高与CAS术后发生ISR关系密切，且狭窄处PSV具有良好的预测价值。

Abstract:

Objective To analyze the value of preoperative ultrasound plaque characteristics in evaluating the risk of in-stent restenosis (ISR) after carotid artery stent implantation (CAS).Methods This study adopted a retrospective analysis method to collect clinical data of a total of 200 patients with carotid artery stenosis who underwent CAS treatment in our hospital. The selection period was from June 2022 to September 2024. According to whether ISR occurred during the follow-up period after CAS, all enrolled patients were divided into the ISR group (36 cases) and the non-ISR group (164 cases). The clinical data and ultrasound plaque characteristics of the ISR group and the non-ISR group were compared, and the influencing factors of ISR after CAS were analyzed. The receiver operating characteristic (ROC) curve was drawn to analyze the evaluation value of peak systolic velocity (PSV) at the stenosis site for the occurrence of ISR after CAS surgery.Results The comparison of hypertension prevalence between the ISR group and the non-ISR group showed a statistically significant difference, indicating that the hypertension prevalence in the ISR group was higher than that in the non-ISR group (P < 0.05). There were statistically significant differences in the composition ratios of plaque shape, echo nature, grade of new blood vessels within the plaque, and PSV at the stenosis site between the ISR group and the non-ISR group (P < 0.05). The composition ratio of irregular plaque shape, low echo nature of echo, grade ≥ 2 of new blood vessels within the plaque, and PSV value at the stenosis site in the ISR group were higher than those in the non-ISR group. Multivariate general Logistic regression analysis was conducted. The results showed that hypertension [O^R = 2.034（95% CI: 1.085, 3.813） ], irregular plaques[O^R = 1.698（95% CI: 1.145, 2.518） ], hypoechoic plaques [O^R = 1.625（95% CI: 1.149, 2.298） ], plaque neovascularization grade ≥ 2 [O^R = 2.231（95% CI: 1.301, 3.826） ], and high PSV [O^R = 1.882（95% CI：1.254，2.825） ] at the stenosis site were all risk factors for ISR after CAS (P < 0.05). The ROC curve analysis showed that the PSV value at the stenosis site had a sensitivity of 72.21%（95% CI: 0.592, 0.824） and a specificity of 75.62%（95% CI: 0.641, 0.899） for predicting ISR after CAS surgery, with an area under the curve of 0.788（95% CI: 0.707, 0.868）.Conclusion Hypertension, irregular plaques, hypoechoic plaques, abundant neovascularization and elevated PSV at the stenosis site are closely related to the occurrence of ISR after CAS, and PSV at the stenosis site has good evaluation value.