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AJNR:CEA后再狭窄的颈动脉血管壁MR特征有助于制订下一步治疗决策

2022-04-26 杨中华 “脑血管病及重症文献导读”公众号

颈动脉内膜切除术(carotid endarterectomy,CEA)能够降低卒中的风险,是严重狭窄的标准治疗方案,术后再狭窄占1-36%,是其长期疗效的重要决定因素。组织学研究表明,复发性颈动脉狭

颈动脉内膜切除术(carotid endarterectomy,CEA)能够降低卒中的风险,是严重狭窄的标准治疗方案,术后再狭窄占1-36%,是其长期疗效的重要决定因素。组织学研究表明,复发性颈动脉狭窄主要是由于术后早期(2年内)的肌内膜增生(myointimal hyperplasia,MH)和术后复发性动脉粥样硬化所致。虽然MH在早期更常见,但其时间跨度很宽,在时间上与复发性动脉粥样硬化有明显的重叠。复发性斑块和MH具有不同的病理成分,可能有助于指导治疗策略。沿着血管壁的MH,其成分变化不大,主要由平滑肌细胞和胶原组成。这些MH病变不容易发生溃疡或发生出血和栓塞,因此针对MH再次进行CEA治疗的获益比治疗复发性斑块的获益更小。如果这些患者无症状且无严重狭窄,则无创性监测可能更适合这些患者。相反,斑块复发特别是具有高风险特征的斑块(脂质核心或斑块内出血[intraplaque hemorrhage,IPH]),更容易引起栓塞和脑血管事件,这些患者需要手术治疗。因此,再次手术之前对颈动脉再狭窄的特征进行评估以确定最佳治疗方案是必要的

图1.从CEA后正常形态发展到MH。CEA手术后2个月,TOF-MRA(A)显示预期的血管形态。ICA近端同一部位(A中的直线)的增强前(B)和增强后(C)血管壁MRI(vessel wall MR imaging,VWMRI)显示血管壁增强,但ICA近端没有血管壁异常增厚(长箭头)。CEA10个月后TOF-MRA(D)显示管腔狭窄。在相同部位(D中的直线)的增强前(E)和增强后(F)VWMRIs显示血管壁环形增厚,伴有轻度不均匀强化,符合MH的特征(长箭头)。B,C,E和F中的短箭头表示颈外动脉

图2.MH示例。TOF-MRA(A)显示CEA后再狭窄,从颈动脉分叉处近端延伸至远端。ICA近端(A中的直线)增强前VWMRI(B)显示血管壁同心均匀增厚(长箭头),提示MH。增强后VWMRI(C)显示病变强化(长箭头)。B和C中的短箭头表示颈外动脉

图3.复发斑块示例。TOF-MRA(A)显示颈动脉球部高度再狭窄。白线表示VWMRI的位置。增强前(B,左图)和增强后(B,右图)VWMR显示血管壁增厚,偏心强化,伴溃疡(星号),提示复发性斑块。MOVAT染色的相应标本切片(C)证实了复发性斑块。星号表示溃疡。B和C中的箭头代表管腔

原始出处:

W Yang, et al. Characterization of Restenosis following Carotid Endarterectomy Using Contrast-Enhanced Vessel Wall MR Imaging. AJNR Am J Neuroradiol. 2022 Mar;43(3):422-428. doi: 10.3174/ajnr.A7423. Epub 2022 Feb 17.

 

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  4. [GetPortalCommentsPageByObjectIdResponse(id=2068764, encodeId=fdc42068e6469, content=<a href='/topic/show?id=0d9b20118c3' target=_blank style='color:#2F92EE;'>#下一步#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20118, encryptionId=0d9b20118c3, topicName=下一步)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Mon Apr 03 14:06:47 CST 2023, time=2023-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709037, encodeId=1c651e09037a7, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Wed May 25 05:06:47 CST 2022, time=2022-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843651, encodeId=e8511843651c1, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Aug 27 02:06:47 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2018083, encodeId=7bc62018083df, content=<a href='/topic/show?id=515b896022b' target=_blank style='color:#2F92EE;'>#血管壁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89602, encryptionId=515b896022b, topicName=血管壁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Tue Sep 13 20:06:47 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486220, encodeId=f4cf148622091, content=<a href='/topic/show?id=15b93065283' target=_blank style='color:#2F92EE;'>#再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30652, encryptionId=15b93065283, topicName=再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488657, encodeId=295a148865edd, content=<a href='/topic/show?id=c6af443e2d' target=_blank style='color:#2F92EE;'>#CEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4437, encryptionId=c6af443e2d, topicName=CEA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce258462097, createdName=shizhenshan, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535889, encodeId=b32915358896d, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541893, encodeId=dcfb1541893c8, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=)]
    2022-09-13 ycmayy
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  6. [GetPortalCommentsPageByObjectIdResponse(id=2068764, encodeId=fdc42068e6469, content=<a href='/topic/show?id=0d9b20118c3' target=_blank style='color:#2F92EE;'>#下一步#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20118, encryptionId=0d9b20118c3, topicName=下一步)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Mon Apr 03 14:06:47 CST 2023, time=2023-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709037, encodeId=1c651e09037a7, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Wed May 25 05:06:47 CST 2022, time=2022-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843651, encodeId=e8511843651c1, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Aug 27 02:06:47 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2018083, encodeId=7bc62018083df, content=<a href='/topic/show?id=515b896022b' target=_blank style='color:#2F92EE;'>#血管壁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89602, encryptionId=515b896022b, topicName=血管壁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Tue Sep 13 20:06:47 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486220, encodeId=f4cf148622091, content=<a href='/topic/show?id=15b93065283' target=_blank style='color:#2F92EE;'>#再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30652, encryptionId=15b93065283, topicName=再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488657, encodeId=295a148865edd, content=<a href='/topic/show?id=c6af443e2d' target=_blank style='color:#2F92EE;'>#CEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4437, encryptionId=c6af443e2d, topicName=CEA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce258462097, createdName=shizhenshan, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535889, encodeId=b32915358896d, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541893, encodeId=dcfb1541893c8, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=)]
    2022-04-27 shizhenshan
  7. [GetPortalCommentsPageByObjectIdResponse(id=2068764, encodeId=fdc42068e6469, content=<a href='/topic/show?id=0d9b20118c3' target=_blank style='color:#2F92EE;'>#下一步#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20118, encryptionId=0d9b20118c3, topicName=下一步)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Mon Apr 03 14:06:47 CST 2023, time=2023-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709037, encodeId=1c651e09037a7, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Wed May 25 05:06:47 CST 2022, time=2022-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843651, encodeId=e8511843651c1, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Aug 27 02:06:47 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2018083, encodeId=7bc62018083df, content=<a href='/topic/show?id=515b896022b' target=_blank style='color:#2F92EE;'>#血管壁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89602, encryptionId=515b896022b, topicName=血管壁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Tue Sep 13 20:06:47 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486220, encodeId=f4cf148622091, content=<a href='/topic/show?id=15b93065283' target=_blank style='color:#2F92EE;'>#再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30652, encryptionId=15b93065283, topicName=再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488657, encodeId=295a148865edd, content=<a href='/topic/show?id=c6af443e2d' target=_blank style='color:#2F92EE;'>#CEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4437, encryptionId=c6af443e2d, topicName=CEA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce258462097, createdName=shizhenshan, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535889, encodeId=b32915358896d, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541893, encodeId=dcfb1541893c8, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=2068764, encodeId=fdc42068e6469, content=<a href='/topic/show?id=0d9b20118c3' target=_blank style='color:#2F92EE;'>#下一步#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20118, encryptionId=0d9b20118c3, topicName=下一步)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Mon Apr 03 14:06:47 CST 2023, time=2023-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709037, encodeId=1c651e09037a7, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=048f31575940, createdName=ms9833124466084992, createdTime=Wed May 25 05:06:47 CST 2022, time=2022-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843651, encodeId=e8511843651c1, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Sat Aug 27 02:06:47 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2018083, encodeId=7bc62018083df, content=<a href='/topic/show?id=515b896022b' target=_blank style='color:#2F92EE;'>#血管壁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89602, encryptionId=515b896022b, topicName=血管壁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Tue Sep 13 20:06:47 CST 2022, time=2022-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486220, encodeId=f4cf148622091, content=<a href='/topic/show?id=15b93065283' target=_blank style='color:#2F92EE;'>#再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30652, encryptionId=15b93065283, topicName=再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488657, encodeId=295a148865edd, content=<a href='/topic/show?id=c6af443e2d' target=_blank style='color:#2F92EE;'>#CEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4437, encryptionId=c6af443e2d, topicName=CEA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce258462097, createdName=shizhenshan, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535889, encodeId=b32915358896d, content=<a href='/topic/show?id=a6326458834' target=_blank style='color:#2F92EE;'>#治疗决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64588, encryptionId=a6326458834, topicName=治疗决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0b12641192, createdName=changhe717, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541893, encodeId=dcfb1541893c8, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Wed Apr 27 03:06:47 CST 2022, time=2022-04-27, status=1, ipAttribution=)]
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