颅内动脉粥样硬化性狭窄闭塞性疾病强化药物治疗下的全血管变化

摘要(中文译文)

强化药物治疗虽可改善颅内动脉粥样硬化性狭窄闭塞性疾病的责任斑块特征，但其对颅内动脉树、静脉通路及脑膜淋巴系统的更广泛影响尚不明确。我们探讨了接受强化治疗的颅内动脉粥样硬化性狭窄闭塞性疾病患者的纵向全血管变化。我们纳入了首次发生颅内动脉粥样硬化性狭窄闭塞性疾病相关卒中、接受强化药物治疗并在基线和6个月随访时接受多模态磁共振成像的患者。定量评估包括责任动脉的斑块负荷和管腔面积、整体动脉树形态、颈内静脉面积及脑膜淋巴管体积。采用校正的广义相加模型分析低密度脂蛋白胆固醇降低与血管指标之间的关联。在24例入组患者中，责任动脉最大狭窄部位的斑块负荷显著降低（平均差值，-5.24%[95%CI，-9.25%至-1.23%]）。整体动脉树长度（平均差值，278.89 mm[95%CI，26.60-531.18 mm]）和体积（平均差值，411.38 mm[95%CI，36.9-785.87 mm]）增加，而平均动脉直径减小（平均差值，-0.05 mm[95%CI，-0.08至-0.01 mm]）。脑膜淋巴管体积亦扩大（平均差值，337.42 mm[95%CI，73.08-601.75 mm]）。颈内静脉横截面积未见显著变化。低密度脂蛋白胆固醇降低幅度越大，与这些全血管指标的改善越明显相关。这些发现揭示了除局部斑块消退之外的动脉和淋巴管协同变化。未来有必要进一步研究以探讨这些系统性变化及其临床意义。

Abstract

While intensive medical therapy improves culprit plaque characteristics in intracranial atherosclerotic steno-occlusive disease, its broader effects on the intracranial arterial tree, venous pathways, and meningeal lymphatic system remain unclear. We explored longitudinal panvascular changes in patients with intracranial atherosclerotic steno-occlusive disease under intensive therapy. We included patients with a first-ever intracranial atherosclerotic steno-occlusive disease-related stroke who received intensive medical therapy and underwent multimodal magnetic resonance imaging at baseline and 6-month follow-up. Quantitative assessments included plaque burden and lumen area at the culprit artery, global arterial tree morphology, internal jugular vein area, and meningeal lymphatic vessel volume. Associations between low-density lipoprotein cholesterol reduction and vascular metrics were analyzed using adjusted generalized additive models. Among 24 enrolled patients, plaque burden at the site of maximal stenosis in the culprit artery decreased significantly (mean difference, -5.24% [95% CI, -9.25% to -1.23%]). Global arterial tree length (mean difference, 278.89 mm [95% CI, 26.60-531.18 mm]) and volume (mean difference, 411.38 mm [95% CI, 36.9-785.87 mm]) increased, while the mean arterial diameter decreased (mean difference, -0.05 mm [95% CI, -0.08 to -0.01 mm]). Meningeal lymphatic vessel volume also expanded (mean difference, 337.42 mm [95% CI, 73.08-601.75 mm]). No significant changes were observed in the cross-sectional area of the internal jugular vein. Greater reduction in low-density lipoprotein cholesterol was associated with more pronounced improvements among these panvascular metrics. These findings reveal coordinated arterial and lymphatic changes beyond local plaque regression. Future studies are warranted to further explore these systemic changes and their clinical implications.

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