Distribution Pattern of Atherosclerotic Stenosis in Chinese Patients with Stroke: A Multicenter Registry Study.

The aim of this multicenter study was to demonstrate the distribution pattern of atherosclerotic stenosis and its trend with aging between extracranial and intracranial arteries and its distribution between the anterior and posterior circulations in Chinese patients hospitalized with ischemic stroke. In addition, the risk factors for the distribution pattern were illustrated. From June 2015 to May 2016, 9,346 patients with ischemic stroke from 20 hospitals were enrolled. Carotid artery ultrasonography and transcranial color-coded sonography/transcranial Doppler were used to evaluate the extracranial and intracranial arteries. The distribution pattern of atherosclerotic stenosis and its trend with aging were analyzed. Logistic regression was used to analyze the risk factors for the distribution pattern. Among the 9,346 patients, 2,882 patients (30.8%) had at least one artery with a degree of stenosis ≥50%. Among patients with arterial stenosis, the proportion of patients with intracranial artery stenosis was higher than those with extracranial artery stenosis (52.6% vs. 27.6%), and the proportion of anterior circulation artery stenosis was higher than that in the posterior circulation (52.2% vs.26.2%). With aging, the proportion of intracranial artery stenosis alone decreased; at the same time, the proportion of extracranial artery stenosis and extracranial plus intracranial artery stenosis increased (trend χ2=6.698, P=0.001). Hypertension (OR 1.416, P=0.008) and family history of stroke (OR 1.479, P=0.014) were risk factors for intracranial artery stenosis. Male, aging, and smoking were factors more related to extracranial artery stenosis. Aging (OR 1.022, P<0.001) and hypertension (OR 1.392, P=0.019) were related to posterior circulation artery stenosis. Intracranial arteries and anterior circulation arteries were susceptible to stenosis in Chinese patients with ischemic stroke. However, the distribution pattern of atherosclerotic stenosis was dynamic and varied with aging. Aging and different risk factors contribute to this distribution pattern.

Shear Wave Elastography Imaging for the Features of Symptomatic Carotid Plaques: A Feasibility Study.

OBJECTIVES: Shear wave elastography (SWE) was performed to evaluate the Young's modulus of carotid plaques in patients presenting with cerebrovascular incidents, to estimate the clinical value and feasibility of this approach. METHODS: Sixty-one patients (mean age, 65 years; 45 men) underwent common duplex ultrasonic examination and SWE evaluation. The patients were divided into the symptomatic and asymptomatic groups based on the presence of unilateral focal neurological symptoms. Elasticity and echogenicity of the carotid plaque was assessed by Young's modulus and Gray-Weale classification, respectively. RESULTS: A total of 271 carotid plaques were assessed through duplex ultrasonic examination and SWE imaging. The Bland-Altman test revealed a perfect reproducibility of Young's modulus measurement using SWE. The interframe coefficient of variation was 16% within the 271 plaques. In the 61 representative plaques, significant correlations were found between Gray-Weale classification and mean Young's modulus (r = 0.728, P < .01) when the confounding factors were controlled. The mean Young's modulus of representative plaques in symptomatic group was lower than those in asymptomatic groups (mean Young's modulus: 81 kPa versus 115 kPa; P < .01). Logistic regression combined with receiver operating characteristic analysis suggested increased sensitivity and specificity for the identification of symptomatic carotid plaques when the mean Young's modulus was combined with stenosis rate. CONCLUSIONS: Shear wave elastography can evaluate the Young's modulus of carotid plaque stably, and could serve as an additional method for the detection of symptomatic carotid plaques, which, in combination with common ultrasound, can promote the efficiency of differentiating symptomatic carotid plaques.