Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?

摘要

Background:Asymptomatic coronary artery stenosis (ACAS) ≥50％ is common in patients with acute ischemic cerebrovascular disease (AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS ≥50％ early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque (AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS ≥50％ in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history.The patients were divided into ACAS ≥50％ and non-ACAS ≥50％ groups according to whether CTA showed stenosis ≥50％ in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118 (24.6％) patients had ACAS ≥50％,while AAPs were observed in 86/118 (72.9 ％) patents.Increased AAP thickness per millimeter (adjusted odds ratio [OR]:1.56,95 ％ confidence interval [CI]:1.18-2.05),severe-extent AAP (adjusted OR:13.66,95％ CI:2.33-80.15),and presence of complex AAP (adjusted OR:7.27,95％ CI:2.30-23.03) were associated with ACAS ≥50％ among patents with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS ≥50％ with an area under the receiver-operating characteristic curve of 0.78 (95％ CI:0.70-0.85,P ＜ 0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50％ in AICVD (all P ＜ 0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS ≥50％ in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS ≥50％ for patients with AICVD.