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• W4383186747 abstract "Objective: To analyze the relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging (MRI) and perioperative hemodynamic instability in patients with severe carotid artery stenosis undergoing carotid artery stenting (CAS). Methods: A total of 89 patients with carotid artery stenosis who underwent CAS treatment at Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January 1, 2017, to December 31, 2021, were prospectively included. Among them, 74 were male and 15 were female, with an age range of 43 to 87 years (mean age: 67.8±8.2 years). Preoperative examinations included carotid artery MRI vessel wall imaging to analyze the existence of large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture in carotid artery plaques. Plaques without the above-mentioned risk factors were defined as stable plaque group (34 cases), while those with such risk factors were defined as vulnerable plaque group (55 cases). The number of risk factors present in each plaque was also calculated. Intraoperative changes in blood pressure and heart rate were recorded, and the use of dopamine postoperatively was noted. Using the risk factors that the plaque has as independent variables and the clinical outcomes as dependent variables, the RR values were calculated, and the differences in clinical outcomes of patients with different risk factors were compared. Results: The incidence rates of hypotension and bradycardia were higher in patients with vulnerable plaques than those with stable plaques (60.0% (33/55) vs 14.7%(5/34) and 38.2%(21/55) vs 14.7%(5/34), respectively; both P<0.05). Based on MRI imaging features, the large LRNC was present in 45 cases, with RR values for hypotension and bradycardia of 3.15 (1.69-5.87) and 2.20 (1.07-4.53), respectively; IPH was present in 37 cases, with RR values for hypotension and bradycardia of 2.70 (1.61-4.55) and 2.25 (1.15-4.39), respectively; and fibrous cap rupture was present in 29 cases, with RR values for hypotension and bradycardia of 1.50 (0.94-2.40) and 1.29 (0.67-2.49), respectively. The higher the number of risk factors in vulnerable plaques, the higher the incidence of intraoperative blood pressure and heart rate decrease: when the number of risk factors ranged from 0 to 3, the incidence of blood pressure decrease was 14.7% (5/34), 9/18, 11/18, and 13/19, respectively (P<0.001), and the incidence of heart rate decrease was 14.7% (5/34), 6/18, 7/18, and 8/19, respectively (P=0.022). There was no significant difference in the number of cases of dopamine use between the two groups (P>0.05). Conclusion: Patients with a higher number of risk factors for vulnerable carotid plaques, as indicated by carotid artery MRI vessel wall imaging, are at a higher risk of experiencing blood pressure and heart rate decrease during CAS surgery.目的： 分析中重度颈动脉狭窄患者的颈动脉粥样硬化斑块MRI血管壁成像特征与颈动脉支架植入术（CAS）围手术期血流动力学不稳定的关系。 方法： 前瞻性纳入自2017年1月1日至2021年12月31日于清华大学附属北京清华长庚医院接受CAS治疗的颈动脉狭窄患者共89例，其中男74例，女15例，年龄43~87（67.8±8.2）岁。术前检查均完善颈动脉MRI血管壁成像，分析颈动脉斑块中是否存在大脂质核、斑块内出血和纤维帽破裂，将不存在上述危险因素的斑块定义为稳定斑块组（34例），反之为易损斑块组（55例），并计算每个斑块具有的危险因素数量。术中记录患者血压、心率的变化及术后多巴胺的使用情况。将斑块具有的危险因素作为自变量，临床结局作为因变量，计算RR值，并比较不同危险因素数量的患者上述临床结局的差异。 结果： 易损斑块组术中血压下降、术中心率下降的发生率高于稳定斑块组［60.0%（33/55）比14.7%（5/34），38.2%（21/55）比14.7%（5/34）；均P<0.05］。MRI血管壁成像特征中，大脂质核45例，对血压下降和心率下降的RR值分别为3.15（1.69~5.87）、2.20（1.07~4.53）；斑块内出血37例，对血压下降和心率下降的RR值分别为2.70（1.61~4.55）、2.25（1.15~4.39）；纤维帽破裂29例，对血压下降和心率下降的RR值分别为1.50（0.94~2.40）、1.29（0.67~2.49）。易损斑块的危险因素越多，术中血压下降和心率下降的发生率越高：危险因素为0~3个时，血压下降发生率分别为14.7%（5/34）、9/18、11/18、13/19（P<0.001），心率下降的发生率分别为14.7%（5/34）、6/18、7/18、8/19（P=0.022）。两组间术后使用多巴胺的患者比例差异无统计学意义（P>0.05）。 结论： 颈动脉斑块MRI血管壁成像提示颈动脉易损斑块危险因素越多的患者在进行CAS时出现血压和心率下降的风险越高。." @default.
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• W4383186747 date "2023-07-04" @default.
• W4383186747 modified "2023-09-25" @default.
• W4383186747 title "[Relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging and perioperative hemodynamic instability]." @default.
• W4383186747 doi "https://doi.org/10.3760/cma.j.cn112137-20221208-02600" @default.
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