Correlation between neutrophil-to-lymphocyte ratio and stability of carotid plaques.

OBJECTIVE: The neutrophil-to-lymphocyte ratio (NLR) has been proved to be a strong predictor of carotid atherosclerotic plaque, but the correlation between NLR and the stability of carotid plaque is not clear. Thus we conducted a study to evaluate the correlation between NLR and the stability of carotid atherosclerotic plaque, and to develop a new evaluation scale for rapid clinical evaluation of carotid plaque stability. METHODS: We recruited 528 patients with acute anterior circulation ischemic stroke who were in accordance with extracranial and intracranial large artery atherosclerosis of Chinese ischemic stroke subtype. Blood routine examination and carotid ultrasound examination were performed on admission. According to the ultrasonic characteristics, the patients were divided into plaque stabilization group and plaque instability group. RESULTS: There was significant difference in NLR between plaque stability and instability groups (P < 0.001). The risk of plaque instability increased with the increase of NLR (odds ratio (OR), 4.737; 95% confidence interval (CI), 3.404-6.592; P < 0.001). Receiver operating characteristic (ROC) curve showed that the critical point of NLR is 2.55 and the area under the curve (AUC) was 0.782 (95%CI, 0.740-0.823; P < 0.001). The best cut-off value of the evaluation scale was ≥ 4 points (sensitivity, 0.77; specificity, 0.75; accuracy, 0.76). CONCLUSION: There is a correlation between NLR and carotid plaque instability. NLR may be useful as a potential inflammation biomarker indicating the risk of unstable carotid plaques. The new scoring scale is a reliable index to predict the stability of carotid plaque.

Usability of Ultrasonic MicroPure Imaging for Evaluating the Vulnerability of Carotid Atherosclerotic Plaques.

OBJECTIVE: MicroPure is an ultrasound imaging technology used for detecting microcalcifications. This study aimed to evaluate the usefulness of the Firefly sign in ultrasonic MicroPure imaging for detecting the vulnerability of carotid plaques. METHODS: Ultrasonic grey-scale imaging was used to detect carotid plaques. Ultrasonic MicroPure imaging was used to detect the Firefly sign and to determine the location and number of Firefly signs. RESULTS: A total of 142 plaques were detected in 72 patients, and 62.0% were Firefly-positive plaques. The length or thickness, the risk of rupture and the percentage of vulnerable plaques were greater in the Firefly-positive plaques than in Firefly-negative plaques. The assessment of plaque vulnerability built on the 4-point Firefly scoring system showed that the area under the ROC curve was 0.750 (P < .001). The sensitivity and specificity of vulnerable plaques with a score of 2 points were 71.9 and 73.6%, respectively. CONCLUSION: The Firefly signs are widely present in carotid atherosclerotic plaques and can be detected with ultrasonic MicroPure imaging. Firefly signs located in fibrous caps may be associated with plaque vulnerability.