The Study On Risk Factors For Carotid Vulnerable Plaque In TOAST Subtype Of Acute Ischemic Stroke

Objective: To investigate the distribution characteristics of carotid plaque in patients with acute ischemic stroke(AIS)and its trial of Org 10172 in acute stroke treatment(TOAST)subtypes of anterior circulation,and explore the risk factors for carotid vulnerable plaque in patients with large artery atherosclerosis(LAA)stroke of anterior circulation.Methods: The clinical data were collected from 588 patients with AIS of anterior circulation and 630 patients free of stroke matched in gender and age admitted to the Department of Neurology in The Second Hospital of Lanzhou University from March 2014 to February 2015.All AIS patients were sub-classified into 5 subtypes according to the TOAST criteria,and the distribution characteristics of carotid plaque between the AIS group with non-stroke group and TOAST subtypes were analyzed.A total of 273 patients with anterior circulation of LAA stroke were divided into non-plaque group(n=84),stable plaque group(n=42),and vulnerable plaque group(n=147)based on the carotid ultrasonography results.Another 182 patients without carotid disease of non-stroke selected simultaneously from our department were regarded as controls.The clinical data were compared among the different four groups.The logistic regression was uesd to screen the independent risk factors for carotid vulnerable plaque in LAA stroke patients.The Spearman rank correlation was performed to analyze the correlation between the carotid plaque vulnerability in LAA stroke patients with all the indicators.Results: 1.The distribution characteristics of carotid plaque between the AIS group with non-stroke group: The distributional difference of carotid plaque between the two groups showed statistically significant difference(P<0.05).The detection rates of carotid plaque in AIS group and non-stroke group were 57.99% and 50.95%,and the detection rates of vulnerable plaque in the two groups were 42.18% and 33.81%,respectively;the detection rates of both carotid plaque and vulnerable plaque were statistically higher in AIS group than in non-stroke group(P<0.05).2.The distribution characteristics of carotid plaque among the TOAST subtypes of AIS patients: The distributional difference of carotid plaque,and the rates of non-plaque,vulnerable plaque among the different 5 sbutypes showed statistically significant differences(P<0.05).The detection rate of vulnerable plaque was statistically higher in LAA sbutype than in small artery occlusion(SAO),stroke of other determined etiology(SOE),and stroke of undetermined etiology(SUE)subtypes;SAO subtype was statistically higher than SUE subtype;cardioembolism(CE)subtype was statistically higher than SOE and SUE subtypes(P<0.05).3.Comparison on clinical data among different groups of LAA stroke patients and controls:The age,gender,history of smoking,and the levels of body mass index(BMI),systolic blood pressure(SBP),fibrinogen(FIB),C-reactive protein(CRP),and homocysteine(Hcy)in the four groups showed statistically significant differences(P<0.05).4.The multivariate logistic regression analysis revealed that age(OR=1.022,95%CI1.003-1.042,P=0.023),male gender(OR=2.061,95%CI 1.340-3.170,P=0.001),SBP(OR=1.014,95%CI 1.003-1.025,P=0.011),and FIB(OR=1.408,95%CI 1.028-1.927,P=0.033)were the independent risk factors for carotid vulnerable plaque in patients with LAA stroke.5.The Spearman correlation analysis presented a positive correlation between carotid plaque vulnerability in LAA stroke patients with age(r=0.154;P=0.001),BMI(r=0.147;P=0.002),SBP(r=0.184;P=0.000),fasting blood glucose [FBG(r=0.096;P=0.040)],FIB(r=0.292;P=0.000),Hcy(r=0.172;P=0.000),and white blood cell [WBC(r=0.104;P=0.027)].Conclusions: 1.The embolism result from thrombosis accompanied by carotid vulnerable plaque rupture or abscission may be one of the main mechanisms for the occurrence of anterior circulation AIS,especially LAA stroke.2.The age,gender,smoking,BMI,SBP,FIB,CRP,and Hcy may have connections with the occurrence of carotid vulnerable plaque in patients with LAA stroke.3.The age,male gender,SBP,and FIB are the independent risk factors for carotid vulnerable plaque in patients with LAA stroke.4.The levels of age,BMI,SBP,FBG,FIB,Hcy,and WBC are positively correlated with carotid plaque vulnerability in patients with LAA stroke.5.The traditional atherosclerosis risk factors,for example,age,gender,SBP,FBG and kinds of inflammatory biomarkers such as FIB,Hcy,and WBC may be the effective predictors for carotid vulnerable plaque in patients with LAA stroke,detection of them jointly can improve the predictive value of carotid vulnerable plaque.6.In addition to traditional risk factors for atherosclerosis,inflammatory response also participates in the pathophysiological processes of atherosclerosis,which plays an important role in the transformation of plaque vulnerability.