| Background:Stroke causes significant mortality and disability in populations worldwide,and its social importance is likely to continue to increase in the coming years due to ongoing demographic changes such as population aging.According to different pathogenesis,strokes are divided into hemorrhagic and ischemic strokes.Ischemic stroke is more common.The reason is that the blood flow to the corresponding brain area is interrupted,resulting in ischemia and hypoxia,which in turn causes the corresponding brain tissue function.loss and death.The clinical manifestations vary according to the location of the affected brain regions.Thrombosis due to atherosclerosis and the resulting stenosis or occlusion of the lumen is the most common cause of ischemic stroke.The index currently used to characterize the severity of atherosclerotic lesions is the degree of stenosis of the lumen.However,measurement of lumen stenosis only by computed tomography angiography or magnetic resonance angiography will underestimate the severity of atherosclerotic disease due to remodeling effects of the arterial vessel wall.While current guidelines primarily rely on the degree of arterial stenosis to determine treatment strategies,the role of vascular remodeling patterns and the clinical significance of atherosclerotic plaque features is growing.Positive remodeling leads to compensatory enlargement of the outer wall of the artery and plaque growth,while negative remodeling leads to inward retraction of the lumen and narrowing of the vessel.Intracranial and extracranial atherosclerotic disease imaging has shifted from indirect assessment of atherosclerosis by measuring luminal narrowing to a more direct assessment of the atherosclerotic plaque itself.The recent emergence of high-resolution magnetic resonance imaging as a new imaging technique can provide information on atherosclerotic plaques and living characteristics of arterial walls before traditional imaging modalities fail to detect vascular stenosis.Provides a solid foundation for early detection of unstable plaques or fragile atherosclerotic lesions with a high risk of rupture.Cystatin C was previously considered to be a sensitive indicator of renal functional status,and more and more studies have shown that it may play an important role in the process of atherosclerosis.This study aimed to investigate the relationship between serum cystatin C and carotid atherosclerosis in patients with acute ischemic stroke by high-resolution magnetic resonance vascular wall imaging.Objective: In this study,patients with acute ischemic stroke caused by atherosclerosis underwent 3.0T carotid artery high-resolution magnetic resonance imaging,and the serum cystatin C level was detected,cmbined with high-resolution magnetic resonance imaging and cystatin C to evaluate the characteristics of carotid atherosclerosis in patients with acute cerebral infarction of large arteries in the carotid system,to explore the value of cystatin C as a serum marker for early prediction of stroke risk.,and to promote high-resolution magnetic resonance imaging in clinical practice.Methods: According to the subject screening criteria,patients with acute ischemic stroke who were admitted to the hospital from May 2019 to February 2022 were selected,and 3.0T carotid artery high-resolution magnetic resonance imaging was performed on them to analyze the carotid artery plaque components and determine the plaque stability.,to calculate the vascular remodeling index.Serum cystatin C levels were detected and divided into homocystatin C group and hypocystatin C group,and plaque stability and vascular remodeling patterns were compared between homocystatin C group and hypocystatin C group difference.Results: A total of 167 cases were included,including 107 in the homocystatin C group and 60 in the low cystatin C group.Two groups of smoking（P=0.070）,drinking（P=0.073）,gender（P=0.921）,hypertension（P=0.534）,diabetes（P=0.136）,coronary heart disease（P=0..758）,total There was no significant difference in cholesterol（P=0.603）,LDL cholesterol（P=0.212）,and blood urea nitrogen（P=0.061）,while age（P=0.0.000）,creatinine（P=0.001）,glycation The difference in hemoglobin（P=0.042）was statistically significant.In terms of plaque stability,the incidence of unstable plaques in the homocystatin C group was higher than that in the hypocystatin C group（P=0.0236）,and the difference was statistically significant.In terms of remodeling composition,the incidence of positive remodeling in the homocystatin C group was higher than that in the hypocystatin C group（P=0.0153）,and the difference was statistically significant.In terms of plaque composition,intraplaque hemorrhage（P=0.024）and lipid-rich necrotic core plaques（P=0.021）in the homocystatin C group were compared with those in the hypocystatin C group.The incidence was grater than that of hypocystatin C group,and the difference was statistically significant.In terms of cystatin C levels and clinical characteristics of AIS patients,there was no significant difference in cystatin C levels between males and females（P=0.545）.However,in the elderly population,serum cystatin C levels were higher（P=0.004）.Serum cystatin C levels were different in patients with different stable plaques,and serum cystatin C levels in patients with unstable plaques were significantly higher than those in patients with stable plaques（P=0.002）.In the comparison of remodeling mothods,the serum cystatin C of positive remodeling wsa significantly higher than that of negtative remodeling and no significant remodeling（P=0.026）.In terms of NIHSS score to assess the severity of stroke,serum cystatin C in patients with NIHSS score>3 points were higher,but the difference was not statistically significant（P=0.143）.Conclusion: In patients with atherosclerotic acute ischemic stroke,elevated serum cystatin C increases the incidence of unstable carotid plaques and posit ive carotid wall remodeling Rate.In addition,high-resolution magnetic resonance vessel wall imaging can detect and evaluate carotid atherosclerosis early,before lumen stenosis occurs in the early stage of carotid atherosclerosis.In the future,whether therapeutic intervention targeting cystatin C can suppress the incidence of unstable carotid plaques and reverse the positive remodeling of the carotid wall requires further investigation. |
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