Carotid Plaque Microcalcification And The Association Between Plaque Vulnerability And Clinical Characteristics In Patients With Atherosclerotic Cerebral Infarction

Objective:To study the characteristics of microcalcification of carotid plaque by ultrasound in patients with cerebral infarction,and to investigate the correlation between microcalcification of carotid plaque and carotid plaque vulnerability and atherosclerotic cerebral infarction.Method:Patients from the Department of Neurology,the Third Affiliated Hospital of Soochow University,who suffered from acute anterior circulation cerebral infarction attributing to intra/extracranial large artery atherosclerosis,were selected from September 2018 to November 2019.The number,echo feature,surface shape and size of carotid plaque were detected by two-dimensional ultrasound,and Ultrasound MicroPure imaging was used to detect the presence of microcalcification in plaque,and the location and number of microcalcifications were recorded.The plaques were divided into stable plaque group and unstable plaque group according to plaque properties.The correlation between microcalcification and plaque vulnerability was statistically analyzed.To analyze the relationship between plaque microcalcification,plaque vulnerability and clinical characteristics of patients.Result:1.A total of 118 patients with anterior circulation cerebral infarction were included.Unstable group(n=81),stable group(n=37),cases with microcalcification(n=90)and without microcalcification(n=28).A total of 236 carotid arteries were detected,of which 31 had no plaque and 205 had plaque.In this study,230 carotid plaques were detected by two-dimensional ultrasound,including 121 unstable plaques and 109 stable plaques.There were 155 plaques with microcalcification and 75 plaques without microcalcification.Of the 121 unstable plaques,99(81.8%)with microcalcification;of the 109 stable plaques,56(51.4%)with microcalcification,and the proportion of plaques with microcalcification(81.8%vs.5 1.4%)was statistically different(P<0.05).2.There was no significant difference in single microcalcification and multiple microcalcifications between stable and unstable plaques by two-dimensional ultrasound,and there was no significant difference between different locations of microcalcification.Binary logistic analysis revealed plaques with microcalcification,which increased the risk of unstable plaques compared to plaques without microcalcification(OR=3.451,95%CI=1.831-6.504).The increase of the length and thickness of plaque in two-dimensional ultrasound,the plaque vulnerability increases(OR=1.085,95%CI=1.025-1.147,OR=1.549,95%CI=1.049-2.287).3.There were differences in the size of plaques with microcalcification and without microcalcification in two-dimensional ultrasound assessment.The length and maximum thickness of plaque with microcalcification were larger than those without microcalcification(P<0.05).There were significant differences in echogenic features between plaques with microcalcification and without microcalcification(P<0.05).There is a high proportion of heterogeneous echo plaques in plaques with microcalcification,and a high proportion of homogeneous hyper-echo and homogeneous hypo-echo plaques in plaques without microcalcification.4.A total of 236 carotid arteries were detected in 118 patients with anterior circulation cerebral infarction.There were 87 patients with plaques in bilateral carotid arteries and 31 patients with plaques in unilateral carotid arteries.A total of 205 carotid arteries have plaques,of which 139 carotid arteries with microcalcification and 66 carotid arteries without microcalcification.There was no significant difference in the proportion of carotid microcalcification between the infarcted side and the non-infarcted side(69.7%vs.65.6%)(P>0.05).Conclusion:1.The microcalcification of carotid plaque can be detected by the combination of two-dimensional ultrasound and Ultrasound MicroPure imaging,which is helpful to evaluate the vulnerability of carotid plaque more accurately in clinic.2.In this study,plaque size and microcalcification are the factors of carotid plaque vulnerability.Plaques with microcalcification tend to have a high risk of unstable plaques.3.In this study,there was no significant correlation between the location and number of microcalcifications and the vulnerability of carotid plaque by two-dimensional ultrasound.4.The correlation between microcalcification of carotid plaque and ipsilateral cerebral infarction is not clear in this study,which needs further study.