| There are two research aspects in this study:(1)The comparative study of carotid Doppler ultrasonography(CDU)and digital subtraction angiography(DSA)in assessing carotid atherosclerotic stenosis;(2)The relationship of cerebral infarction with carotid artery stenosis and plaque properties.Part I The comparative study of CDU and DSA in assessing carotid atherosclerotic stenosisObjective:The consistency of the diagnosis of carotid atherosclerotic stenosis between CDU and DSA was examined.Method:1.Clinical data: 91 patients with carotid atherosclerotic stenosis who underwent CDU and DSA examinations at the stroke center of the First Affiliated Hospital of Suzhou University from January 2017 to September 2017 were selected as study subjects.A total of 182 blood vessels were included.2.CDU examination: Atherosclerotic stenosis of 182 carotid arteries was examined,including blood vessel cross-section and longitudinal section,proximal segment to distal segment,two-dimensional gray-scale imaging observation of the wall and lumen,color Doppler flow imaging(CDFI)was used to observe blood flow filling and pulse,pulsed wave doppler(PW)to observe the spectrum of blood flow and record hemodynamic parameters,including peak systolic velocity(PSV)?end diastolic velocity(EDV)and resistance index(RI).3.DSA examination: Selective angiography and whole cerebral angiography on the aortic arch.Rotation imaging was performed on all cases.The caliber of the narrowest part and the normal vascular diameter of the distal part were measured,and the diameter stenosis rate was calculated.4.Statistical methods: The hemodynamic parameters of CDU examination were analyzed by single factor analysis of variance.The diagnosis results of CDU and DSA were tested by Kappa consistency and matched with chi-square test.The degree of stenosis diagnosed by DSA was used as a "gold standard" to assess the compliance,sensitivity,specificity,positive predictive value,and negative predictive value of CDU in the diagnosis of vascular stenosis.Results:1.Results of CDU examination: Atherosclerotic plaques of various morphological and echogenic types as well as plaque-induced luminal stenosis were observed in the lumen of the carotid artery.There was no blood flow signal in the lumen of carotid artery occlusion.In the absence of carotid artery stenosis,mild stenosis,moderate stenosis,and severe stenosis,the hemodynamic parameters PSV and EDV increased with the severity of stenosis,and the difference was statistically significant(p<0.05).There was no significant difference in RI values(p >0.05).2.Evaluation of carotid artery stenosis by CDU and DSA: CDU assessment showed no significant stenosis of the carotid artery 62,mild stenosis 35,moderate stenosis 19,severe stenosis 46 and occlusion 20;DSA assessment of no significant stenosis 60,mild stenosis 36,moderate stenosis 23,severe stenosis 42 and occlusion 21.The results of the two examination methods had excellent consistency(Kappa=0.871,p<0.05),and there was no significant difference in the paired chi-square test results(p>0.05).The results of evaluation of CDU by DSA diagnosis of carotid atherosclerotic stenosis as "gold standard" showed that the sensitivity was 95.08%,specificity was 93.33%,positive predictive value was 96.66%,negative predictive value was 90.32%,and the overall coincidence rate 94.51%.3.Distribution of carotid atherosclerotic stenosis: The internal carotid artery(ICA)origination area was 56.56%(69/122),with statistical significance(p<0.05);the left and right sides were 70.33%(64/91)and 63.74%(58/91),respectively.There was no significant difference between the two sides(p> 0.05).Conclusion:1.Non-invasive,real-time,and dynamic assessment of carotid atherosclerotic stenosis can be performed with cervical vascular ultrasound.This method has good consistency with DSA diagnosis.Part II.The relationship between carotid artery stenosis,plaque properties and cerebral infarctionObjective:To investigate the relationship between carotid atherosclerotic stenosis,plaque properties,and cerebral infarction in the blood supply area.Method:1.Clinical data: Same as the first part.2.Assessment of plaque properties by CDU: The surface morphology and internal echo characteristics of carotid atherosclerotic plaques were observed by two-dimensional gray-scale imaging.The CDFI was used to observe whether there was filling defect in the blood flow at the plaque and whether there was blood flow signal in the plaque.Then determine the nature of the plaque.3.DSA assessment of carotid stenosis: The same as the first part.4.Computer tomography and/or magnetic resonance imaging for diagnosis of cerebral infarction: According to the density value on the CT image,the signal level on the MRI image,combined with the course of the disease,to determine the cerebral infarction.5.Statistical methods: The chi-square test was used to analyze the correlation between carotid atherosclerotic stenosis,vulnerable plaque,and cerebral infarction in the blood supply area.All test results were statistically significant at p<0.05.Results:1.The correlation of carotid artery stenosis and cerebral infarction in the blood supply area: When the carotid artery is not significantly stenosis,mild stenosis,moderate stenosis,severe stenosis and occlusion,the probability of cerebral infarction in the blood supply area were 30%,36.11%,65.22%,69.05% and 95.24%,respectively.The difference was statistically significant(c2 = 35.564,p<0.05).2.The correlation between vulnerable plaque and cerebral infarction in blood supply area: When the carotid artery has vulnerable plaque and no vulnerable plaque,the probability of cerebral infarction in the blood supply area were 70.97% and 32.58%,respectively.The difference was statistically significant(c2=15.762,p<0.05).3.The correlation of carotid stenosis and vulnerable plaques: When the carotid artery was not significantly narrowed,mildly stenotic,moderately stenotic,severely stenotic,and occluded,the probability of vulnerable plaques were 21.67%,38.89%,56.52%,76.19% and 100%,respectively.The difference was statistically significant(c2 = 32.516,p <0.05).Conclusion:1.The degree of carotid artery stenosis and vulnerable plaques are closely related to the probability of cerebral infarction in the carotid artery blood supply area. |
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