Predictive Value Of Vascular Remodeling And Plaque CEUS For Ischemic Cerebral Symptoms In Patients With Moderate-severe Carotid Atherosclerotic Stenosis

ObjectiveTo investigate the predictive value of carotid artery remodeling index(CRI),carotid plaque CEUS neovascularization grade and their combination in predicting for clinical ischemic symptoms in patients with moderate-severe carotid stenosis.Materials and methodsA total of 107 continuous patients with unilateral moderate-severe carotid artery stenosis(stenosis rate 50%to 99%)who underwent CEA surgical treatment were enrolled retrospectively in the Department of Vascular Surgery of the Fifth Affiliated Hospital of Zhengzhou University from March 2019 to February 2021.According to the ischemic cerebral symptoms,patients were divided into the symptom group(65cases)and the asymptomatic group(42 cases).The general clinical data,CRI,CEUS neovascularization grade and echo of plaque were compared between the two groups.The univariate and multivariate logistic regression models were established and analyzed.The value of CRI,CEUS neovascularization grade and their combination variables for predicting moderate-severe carotid artery stenosis ischemic cerebral events was analyzed through the ROC curve.Results1.There were no significant differences in age,gender and risk factors of cerebrovascular disease between the the symptom group and the asymptomatic group(all P>0.05).2.The proportions of CEUS neovascularization grade I,II,III plaques in the symptom group for 4.6%,32.3%,63.1%,respectively,the proportions of CEUS neovascularization grade I,II,III plaques in the asymptomatic group for 50.0%,40.5%,9.5%.The overall comparison between the two groups of neovascularization grades was statistically significant(P<0.01),CEUS neovascularization grade I plaques in the symptom group is lower than the asymptomatic group,and II,III plaques are higher than the asymptomatic group.The difference between the two groups of neovascularization grade I and III plaques is statistically differences(P<0.01),and there is no statistically difference between II plaques(P>0.05).There were higher in the ratio of CRI[1.77(1.69,1.88)vs.1.68(1.62,1.76)]in the symptom group compared with the asymptomatic group(all P<0.01).3.The univariate、multivariate logistic regression analysis showed that CRI(univariate:OR=5.50,95%CI:2.26～13.37,P<0.01;multivariate:OR=3.12,95%CI:1.09～8.93,P=0.034),CEUS neovascularization grade(univariate:OR=8.45,95%CI:3.85～18.57,P<0.01;multivariate:OR=7.20,95%CI:3.23～16.07,P<0.01)were independent risk factors for ischemic cerebral events.4.ROC curve analysis results show that the area under the curve predicted moderate-severe carotid artery stenosis ischemic cerebral symptom by CEUS neovascularization grade is larger than CRI urve(AUC=0.839 vs.AUC=0.724)is statistically significant(P<0.05),and the area under the prediction of two combined variables curve(AUC=0.871)is the largest,and the difference is statistically significant compared with the prediction of single variables(all P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value of CRI(cutoff value≥1.75)for predicting moderate-severe carotid artery stenosis ischemic cerebral symptoms are 60.0%,78.6%,81.2%,55.9%,CEUS neovascularization grade(cutoff value>II)for predicting are 63.1%,90.5%,91.1%,61.3%,and two combined variables for predicting are 72.3%,90.5%,92.2%,67.9%.5.Correlation analysis showed that there was a positive correlation between CRI and CEUS neovascularization in patients with moderate to severe carotid artery stenosis(r_s=0.374,P<0.01).Conclusion1.CEUS neovascularization grade and CRI ratio can increase the risk of cerebral ischemic events in patients with moderate to severe carotid stenosis.2.CRI ratio can try to predict cerebral ischemic events in patients with moderate-severe carotid stenosis,and CRI ratio combination with CEUS neovascularization grade can make the prediction effect better.