Lumen structure and hemodynamic characteristics of occluded internal carotid artery

doi:10.3877/cma.j.issn.1672-6448.2023.08.005

Abstract

Abstract:

Objective

To investigate the characteristics of lumen structure and intracranial and extracranial hemodynamic parameters in patients with internal carotid artery occlusion (ICAO) in acute and chronic stages by combining carotid Doppler ultrasound (CDU) and transcranial color Doppler (TCCD).

Methods

Patients admitted to the Department of Neurology or Neurosurgery of Xuanwu Hospital of Capital Medical University due to ICAO-related cerebral infarction from September 2017 to October 2021 were retrospectively and consecutively enrolled. According to the course of disease, the ICAO patients were divided into acute (≤4 weeks) and chronic (>4 weeks) groups. CDU and TCCD were used to detect the carotid lumen structure and intracranial and external arterial blood flow parameters in ICAO patients. The characteristic parameters were compared between the acute stage group and chronic stage group. The risk factors related to the acute course of ICAO were identified by univariate and Logistic regression analyses.

Results

A total of 386 ICAO-related cerebral infarction patients were included, including 165 in the acute stage group and 221 in the chronic stage group. The proportion of women in the acute stage group was 13.3%, higher than that of the chronic phase group (6.8%, P=0.031). The incidence of coronary heart disease in the acute stage group was 26.1%, which was higher than that of the chronic stage group (16.3%, P=0.019). The proportion of hypoechoic plaques in the acute phase group was higher than that of the chronic stage group (73.3% vs 58.4%, P=0.002). The mean pulsatility index of the middle cerebral artery in the acute stage group was 0.61±0.12, which was lower than that of the chronic phase group (0.63±0.14, P=0.037). Logistic multivariate regression analysis demonstrated that female gender (odds ratio [OR]: 2.124, 95% confidence interval [CI]: 1.042-4.331, P=0.038), history of coronary heart disease (OR: 2.063, 95%CI: 1.227-3.470, P=0.006), mainly hypoechoic plaques (OR: 2.093, 95%CI: 1.332-3.291, P=0.001), and low pulsatility index of the affected middle cerebral artery (OR: 0.183, 95%CI: 0.036-0.930, P=0.041) were independent risk factors for the acute course of ICAO patients.

Conclusions

The characteristics of lumen structure and intracranial hemodynamics are different between patients with acute and chronic ICAO. CDU combined with TCCD can evaluate the characteristics of patients' lesions and help clinicians make treatment decisions.

Key words: Internal carotid artery occlusion, Cerebral infarction, Ultrasonography, Doppler, transcranial, Collateral circulation, Risk factors

Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.08.005

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Figures/Tables 9

References 22

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临床资料	慢性期组（221例）	急性期组（165例）	统计值	P值
年龄（岁，）	62±9	61±9	t=-1.035	0.301
闭塞侧别（右）	120（54.3）	89（53.9）	χ²=0.004	0.944
性别（女）	15（6.8）	22（13.3）	χ²=0.109	0.031
年龄>60岁	149（67.4）	100（60.6）	χ²=0.070	0.166
高血压	141（63.8）	115（69.7）	χ²=0.062	0.225
冠心病	36（16.3）	43（26.1）	χ²=0.119	0.019
糖尿病	74（33.5）	55（33.3）	χ²=0.002	0.975
高脂血症	97（43.9）	88（53.3）	χ²=0.093	0.066
吸烟	156（70.6）	107（64.8）	χ²=0.061	0.231
心房颤动	2（0.9）	3（1.8）	χ²=0.040	0.432
脑梗死病史	70（31.7）	41（24.8）	χ²=0.074	0.143
BMI（kg/m²，）	24.98±2.98	25.37±2.89	t=-1.292	0.197

临床资料	慢性期组（221例）	急性期组（165例）	统计值	P值
年龄（岁，）	62±9	61±9	t=-1.035	0.301
闭塞侧别（右）	120（54.3）	89（53.9）	χ²=0.004	0.944
性别（女）	15（6.8）	22（13.3）	χ²=0.109	0.031
年龄>60岁	149（67.4）	100（60.6）	χ²=0.070	0.166
高血压	141（63.8）	115（69.7）	χ²=0.062	0.225
冠心病	36（16.3）	43（26.1）	χ²=0.119	0.019
糖尿病	74（33.5）	55（33.3）	χ²=0.002	0.975
高脂血症	97（43.9）	88（53.3）	χ²=0.093	0.066
吸烟	156（70.6）	107（64.8）	χ²=0.061	0.231
心房颤动	2（0.9）	3（1.8）	χ²=0.040	0.432
脑梗死病史	70（31.7）	41（24.8）	χ²=0.074	0.143
BMI（kg/m²，）	24.98±2.98	25.37±2.89	t=-1.292	0.197

管腔结构特征	慢性期组（221例）	急性期组（165例）	统计值	P值
斑块低回声为主[例（%）]	129（58.4）	121（73.3）	χ²=0.153	0.002
斑块内有钙化[例（%）]	157（71.0）	111（67.3）	χ²=0.040	0.427
斑块钙化类型[例（%）]			χ²=0.062	0.474
无钙化	64（29.0）	54（32.7）
点状钙化	31（14.0）	17（10.3）
基底部钙化	126（57.0）	94（57.0）
患侧CCA远段内径（mm，）	7.05±1.25	7.00±1.21	t=-0.954	0.340
患侧颈动脉球部内径（mm，）	6.84±1.47	6.85±1.27	t=-0.071	0.943
患侧ICA近段内径（mm，）	3.43±1.05	3.61±1.18	t=-1.336	0.182

管腔结构特征	慢性期组（221例）	急性期组（165例）	统计值	P值
斑块低回声为主[例（%）]	129（58.4）	121（73.3）	χ²=0.153	0.002
斑块内有钙化[例（%）]	157（71.0）	111（67.3）	χ²=0.040	0.427
斑块钙化类型[例（%）]			χ²=0.062	0.474
无钙化	64（29.0）	54（32.7）
点状钙化	31（14.0）	17（10.3）
基底部钙化	126（57.0）	94（57.0）
患侧CCA远段内径（mm，）	7.05±1.25	7.00±1.21	t=-0.954	0.340
患侧颈动脉球部内径（mm，）	6.84±1.47	6.85±1.27	t=-0.071	0.943
患侧ICA近段内径（mm，）	3.43±1.05	3.61±1.18	t=-1.336	0.182

参数	慢性期组（221例）	急性期组（165例）	统计值	P值
患侧CCA
PSV	53（33.0）	58（30.0）	Z=-1.798	0.072
EDV	11（7.0）	12（8.0）	Z=-0.976	0.329
健侧CCA
PSV	77（42.0）	80（36.5）	Z=-0.367	0.714
EDV	25（14.0）	25（14.0）	Z=-0.097	0.923
患侧ECA
PSV	124（80.0）	122（81.5）	Z=-0.305	0.760
EDV	21（13.0）	22（14.5）	Z=-0.549	0.583
健侧ECA
PSV	130（76.0）	124（69.5）	Z=-0.903	0.366
EDV	22（14.0）	22（13.0）	Z=-0.138	0.890
健侧ICA
PSV	108（65.5）	102（45.5）	Z=-1.158	0.247
EDV	44（28.0）	41（23.0）	Z=-1.559	0.119
患侧MCA
PSV	59（31.5）	57（38.0）	Z=-1.595	0.111
EDV	33（16.0）	31（20.5）	Z=-1.411	0.158
PI（）	0.63±0.14	0.61±0.12	t=2.098	0.037
健侧MCA
PSV	113（63.5）	115（68.0）	Z=-0.391	0.695
EDV	50（25.0）	51（31.5）	Z=-0.912	0.362
PI（）	0.85±0.19	0.84±0.19	t=0.267	0.789

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