usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494Vidar Ltd.usfd-256Research ArticleУльтразвуковая диагностика заболеваний сердца и сосудовCardiovascular UltrasoundАкустические характеристики атеросклеротических бляшек, влияющие на их эмбологенность, у пациентов с полушарным ишемическим инсультомGray-Scale Median Analysis of Atherosclerotic Carotid Plaques in Patients with Hemispheric Ischemic StrokeОрловаЕкатерина ВладимировнаOrlovaE. V.ekaterina.shlyk@gmail.comЛелюкС. Э.LelyukS. Eh.noemail@neicon.ruЛелюкВ. Г.LelyukV. G.noemail@neicon.ruФГБОУ ВО “Российский национальный исследовательский медицинский университет имени Н.И. Пирогова” Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research Medical UniversityRussian FederationФГБОУ ДПО “Российская медицинская академия последипломного образования” Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Postgraduate EducationRussian Federation201630032024054259Copyright © Орлова Е.В., Лелюк С.Э., Лелюк В.Г., 20242024Орлова Е.В., Лелюк С.Э., Лелюк В.Г.Orlova E.V., Lelyuk S.E., Lelyuk V.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.vidar.ru/jour/article/view/256

Целью настоящего исследования явилось изучение субъективных и объективных эхографических характеристик атеросклеротических бляшек, а также других факторов, которые могут оказывать влияние на их эмбологенность, у больных с ишемическим инсультом. Проанализированы сведения о 43 пациентах, которым проводилось комплексное ультразвуковое исследование, включающее дуплексное сканирование экстра- и интракраниальных артерий и транскраниальное допплеровское мониторирование с микроэмболодетекцией. Осуществлялась обработка эхограмм атеросклеротических бляшек с помощью различных модификаций GSM-анализа (grey-scale median). Для эмбологенных атеросклеротических бляшек характерны гиперподвижность покрышки, а также наличие участков, подозрительных на атипичную подвижность. Возникновение микроэмболии связано с наличием осложнений атеросклеротических бляшек, неровной их поверхностью. Объективные характеристики атеросклеротических бляшек, вычисленные с помощью GSM-анализа, имеют свои аналоги среди субъективных, достоверно отличаются у эмбологенных и неэмбологенных атеросклеротических бляшек. Все качественные и количественные характеристики атеросклеротических бляшек по своему влиянию на эмбологенность могут быть разделены на факторы, связанные с осложнениями, а также размерами и особенностями поверхности атеросклеротических бляшек. GSM-показатели в виде комплексной функции с определенными значениями веса каждого из них являются способом классификации атеросклеротических бляшек на эмбологенные и неэмбологенные. Субъективные и объективные параметры, отражающие структуру атеросклеротических бляшек, оказывают влияние на биофизические свойства микроэмболических сигналов, косвенно связанные с размерами и плотностью эмболов.

Aim of this study was to elaborate the subjective and objective acoustic characteristics of atherosclerotic plaques and other factors affecting the risk of embolism in patients with hemispheric ischemic stroke. 43 patients underwent ultrasound examination including the Doppler study of extracranial and intracranial arteries and transcranial Doppler monitoring with detection of microemboli. Different modifications of GSM-analysis (grey-scale median) were used for post processing of ultrasound images. Unstable atherosclerotic plaques presented hypermobility of the surface and areas with high suspicion for atypical mobility. Objective characteristics of atherosclerotic plaques, computed using the GSM-analysis, had their counterparts among the subjective. They are significantly differing in stable and unstable atherosclerotic plaques. All qualitative and quantitative characteristics of atherosclerotic plaques in their influence on plaque instability can be divided into factors related to complications, size, and surface type of atherosclerotic plaques. GSM-analysis allowed classifying atherosclerotic plaques into stable and unstable. Subjective and objective atherosclerotic plaques parameters, reflecting their structure, affect the biophysical characteristics of the emboli signals indirectly connected with their size and density.

дуплексное ультразвуковое сканированиеатеросклеротическая бляшкаэмболияGSM-анализмикроэмболодетекцияduplex ultrasoundatherosclerotic plaqueembolismGSM-analysisdetection of microemboliReferencesАхметов В.В., Алексеечкина О.А., Леменев В.Л. Роль дуплексного и ангиоскопического исследования у больных с поражением сонных артерий в выявлении причин ПНМК // Журнал неврологии и психиатрии. 2003. Вып. 9. С. 143-144.Ахметов В.В., Алексеечкина О.А., Леменев В.Л. Роль дуплексного и ангиоскопического исследования у больных с поражением сонных артерий в выявлении причин ПНМК // Журнал неврологии и психиатрии. 2003. Вып. 9. С. 143-144.Джибиладзе Д.Н., Покровский А.В., Никитин Ю.М. Значение структуры атеросклеротических бляшек и степени стеноза внутренней сонной артерии в клинике ишемических нарушений мозгового кровообращения // Ангиология и сосудистая хирургия. 1997. Вып. 2. С. 22-32.Джибиладзе Д.Н., Покровский А.В., Никитин Ю.М. Значение структуры атеросклеротических бляшек и степени стеноза внутренней сонной артерии в клинике ишемических нарушений мозгового кровообращения // Ангиология и сосудистая хирургия. 1997. Вып. 2. С. 22-32.Denzel C., Balzer K., Muller K.M. et al. Relative value of normalized sonographic in vitro analysis of arteriosclerotic plaques of internal carotid artery // Stroke. 2003. V. 34. No. 8. P. 1901-1906.Denzel C., Balzer K., Muller K.M. et al. Relative value of normalized sonographic in vitro analysis of arteriosclerotic plaques of internal carotid artery // Stroke. 2003. V. 34. No. 8. P. 1901-1906.Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. Изд. 3-е, доп. и перераб. М.: Реальное время, 2007. 416 с.Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. Изд. 3-е, доп. и перераб. М.: Реальное время, 2007. 416 с.Ritter M.A., Dittrich R., Thoenissen N. et al. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature // J. Neurol. 2008. V. 255. No. 7. Р. 953-961.Ritter M.A., Dittrich R., Thoenissen N. et al. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature // J. Neurol. 2008. V. 255. No. 7. Р. 953-961.Segura T., Serena J., Casteltanos M. et al. Embolism in acute middle cerebral artery stenosis // Neurology. 2001. V. 56. No. 4. P. 497-501.Segura T., Serena J., Casteltanos M. et al. Embolism in acute middle cerebral artery stenosis // Neurology. 2001. V. 56. No. 4. P. 497-501.Telman G., Kouperberg E., Hlebtovsky A. et al. Determinants of micro-embolic signals in patients with atherosclerotic plaques of the internal carotid artery // Eur. J. Vasc. Endovasc. Surg. 2009. V. 38. No. 2. Р. 143-147.Telman G., Kouperberg E., Hlebtovsky A. et al. Determinants of micro-embolic signals in patients with atherosclerotic plaques of the internal carotid artery // Eur. J. Vasc. Endovasc. Surg. 2009. V. 38. No. 2. Р. 143-147.Markus H., Loh A., Brown M.M. et al. Computerized detection of cerebral emboli and discrimination from artifact using Doppler ultrasound // Stroke. 1993. V. 24. No. 11. P. 1667-1672.Markus H., Loh A., Brown M.M. et al. Computerized detection of cerebral emboli and discrimination from artifact using Doppler ultrasound // Stroke. 1993. V. 24. No. 11. P. 1667-1672.Russell D., Brucher R. et al. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler // Stroke. 2002. V. 33. No. 8. P. 1975-1980.Russell D., Brucher R. et al. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler // Stroke. 2002. V. 33. No. 8. P. 1975-1980.Graebe M., Pedersen S.F., Hojgaard L. et al. 18FDG PET and ultrasound echolucency in carotid artery plaques // JACC Cardiovasc. Imaging. 2010. V. 3. No. 3. Р. 289-295.Graebe M., Pedersen S.F., Hojgaard L. et al. 18FDG PET and ultrasound echolucency in carotid artery plaques // JACC Cardiovasc. Imaging. 2010. V. 3. No. 3. Р. 289-295.Sabetai M.M., Tegos T.J., Nicolaides A.N. et al. Reproducibility of computer-quantified carotid plaque echogenicity: can we overcome the subjectivity? // Stroke. 2000. V. 31. No. 9. P. 2189-2196.Sabetai M.M., Tegos T.J., Nicolaides A.N. et al. Reproducibility of computer-quantified carotid plaque echogenicity: can we overcome the subjectivity? // Stroke. 2000. V. 31. No. 9. P. 2189-2196.Lal B.K., Hobson R.W., Pappas P.J. et al. Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques // J. Vasc. Surg. 2002. V. 35. No. 6. P. 1210-1217.Lal B.K., Hobson R.W., Pappas P.J. et al. Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques // J. Vasc. Surg. 2002. V. 35. No. 6. P. 1210-1217.Biasi G.M., Mingazzini P.M., Baronio L. et al. Carotid plaque characterization using digital image processing and its potential in future studies of carotid endarterectomy and angioplasty // J. Endovasc. Surg. 1998. V. 5. No. 3. P. 240-246.Biasi G.M., Mingazzini P.M., Baronio L. et al. Carotid plaque characterization using digital image processing and its potential in future studies of carotid endarterectomy and angioplasty // J. Endovasc. Surg. 1998. V. 5. No. 3. P. 240-246.Falkowski A., Kaczmarczyk M., Cieszanowski A. et al. Computer-assisted characterisation of a carotid plaque // Med. Sci. Monit. 2004. V. 10. No. 3. Р. 67-70.Falkowski A., Kaczmarczyk M., Cieszanowski A. et al. Computer-assisted characterisation of a carotid plaque // Med. Sci. Monit. 2004. V. 10. No. 3. Р. 67-70.Goncalves I., Lindholm M.W., Pedro L.M. et al. Elastin and calcium rather than collagen or lipid content are associated with echogenicity of human carotid plaques // Stroke. 2004. V. 35. No. 12. Р. 2795-2800.Goncalves I., Lindholm M.W., Pedro L.M. et al. Elastin and calcium rather than collagen or lipid content are associated with echogenicity of human carotid plaques // Stroke. 2004. V. 35. No. 12. Р. 2795-2800.Tegos T.J., Sohail M., Sabetai M.M. et al. Echomorphologic and histopathologic characteristics of unstable carotid plaques // Am. J. Neuroradiol. 2000. V. 21. No. 10. P. 1937-1944.Tegos T.J., Sohail M., Sabetai M.M. et al. Echomorphologic and histopathologic characteristics of unstable carotid plaques // Am. J. Neuroradiol. 2000. V. 21. No. 10. P. 1937-1944.Grogan J.K., Shaalan W.E., Cheng H. et al. B-mode ultrasonographic characterization of carotid athero sclerotic plaques in symptomatic and asymptomatic patients // J. Vasc. Surg. 2005. V. 42. No. 3. P. 435-441.Grogan J.K., Shaalan W.E., Cheng H. et al. B-mode ultrasonographic characterization of carotid athero sclerotic plaques in symptomatic and asymptomatic patients // J. Vasc. Surg. 2005. V. 42. No. 3. P. 435-441.Gronholdt M.M., Nordestgaard B.G., Bentzon J. et al. Macrophages are associated with lipid-rich carotid artery plaques, echolucency on B-mode imaging, and elevated plasma lipid levels // J. Vasc. Surg. 2002. V. 35. No. 1. P. 137-145.Gronholdt M.M., Nordestgaard B.G., Bentzon J. et al. Macrophages are associated with lipid-rich carotid artery plaques, echolucency on B-mode imaging, and elevated plasma lipid levels // J. Vasc. Surg. 2002. V. 35. No. 1. P. 137-145.Gronholdt M.M., Nordestgaard B.G., Wiebe B.M. et al. Echo-lucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content // Circulation. 1998. V. 97. No. 1. P. 34-40.Gronholdt M.M., Nordestgaard B.G., Wiebe B.M. et al. Echo-lucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content // Circulation. 1998. V. 97. No. 1. P. 34-40.Polak J.F., Shemanski L., O’Leary D.H. et al. Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults 65 years or older // Radiology. 1998. V. 208. No. 3. P. 649-654.Polak J.F., Shemanski L., O’Leary D.H. et al. Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults 65 years or older // Radiology. 1998. V. 208. No. 3. P. 649-654.Griffin M., Nicolaides A., Kyriacou E. et al. Normalization of ultrasonic images of atherosclerotic plaques and reproducibility of grey scale median using dedicated software // Int. Angiol. 2007. V. 26. No. 4. Р. 372-377.Griffin M., Nicolaides A., Kyriacou E. et al. Normalization of ultrasonic images of atherosclerotic plaques and reproducibility of grey scale median using dedicated software // Int. Angiol. 2007. V. 26. No. 4. Р. 372-377.Sztajzel R., Momjian S., Murith N. et al. Stratified gray-scale median analysis and color mapping of the carotid plaque: correlation with endarterectomy specimen histology of 28 patients // Stroke. 2005. V. 36. No. 4. P. 741-745.Sztajzel R., Momjian S., Murith N. et al. Stratified gray-scale median analysis and color mapping of the carotid plaque: correlation with endarterectomy specimen histology of 28 patients // Stroke. 2005. V. 36. No. 4. P. 741-745.Sztajzel R., Momjian-Mayor I., Comelli M. et al. Correlation of cerebrovascular symptoms and micro embolic signals with the stratified gray-scale median analysis and color mapping of the carotid plaque // Stroke. 2006. V. 37. No. 3. P. 824-829.Sztajzel R., Momjian-Mayor I., Comelli M. et al. Correlation of cerebrovascular symptoms and micro embolic signals with the stratified gray-scale median analysis and color mapping of the carotid plaque // Stroke. 2006. V. 37. No. 3. P. 824-829.Malik R.K., Landis G.S., Sundick S. et al. Predicting embolic potential during carotid angioplasty and stenting: analysis of captured particulate debris, ultrasound characteristics, and prior carotid endarterectomy // J. Vasc. Surg. 2010. V. 51. No. 2. Р. 317-322.Malik R.K., Landis G.S., Sundick S. et al. Predicting embolic potential during carotid angioplasty and stenting: analysis of captured particulate debris, ultrasound characteristics, and prior carotid endarterectomy // J. Vasc. Surg. 2010. V. 51. No. 2. Р. 317-322.Nicolaides A.N., Kakkos S.K., Kyriacou E. et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification // J. Vasc. Surg. 2010. V. 52. No. 6. Р. 1486-1496.Nicolaides A.N., Kakkos S.K., Kyriacou E. et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification // J. Vasc. Surg. 2010. V. 52. No. 6. Р. 1486-1496.Гулевская Т.С., Моргунов В.А., Ануфриев П.Л. и др. Морфологическая структура атеросклероти ческих бляшек синуса внутренней сонной арте рии и их ультразвуковая характеристика // Ультразвуковая и функциональная диагностика. 2004. № 4. С. 68-77.Гулевская Т.С., Моргунов В.А., Ануфриев П.Л. и др. Морфологическая структура атеросклероти ческих бляшек синуса внутренней сонной арте рии и их ультразвуковая характеристика // Ультразвуковая и функциональная диагностика. 2004. № 4. С. 68-77.Sztajzel R. Ultrasonographic assessment of the morphological characteristics of the carotid plaque // Swiss. Med. Wkly. 2005. V. 135. No. 43-44. Р. 635-643.Sztajzel R. Ultrasonographic assessment of the morphological characteristics of the carotid plaque // Swiss. Med. Wkly. 2005. V. 135. No. 43-44. Р. 635-643.Tegos T.J., Kalomiris K.J., Sabetai M.M. et al. Significance of sonographic tissue and surface characteristics of carotid plaques // Am. J. Neuroradiol. 2001. V. 22. No. 8. P. 1605-1612.Tegos T.J., Kalomiris K.J., Sabetai M.M. et al. Significance of sonographic tissue and surface characteristics of carotid plaques // Am. J. Neuroradiol. 2001. V. 22. No. 8. P. 1605-1612.Biasi G.M., Froio A., Diethrich E.B. et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study // Circulation. 2004. V. 110. No. 6. P. 756-762.Biasi G.M., Froio A., Diethrich E.B. et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study // Circulation. 2004. V. 110. No. 6. P. 756-762.Sabetai M.M., Tegos T.J., Nicolaides A.N. et al. Hemispheric symptoms and carotid plaque echomorphology // J. Vasc. Surg. 2000. V. 31. P. 39-49.Sabetai M.M., Tegos T.J., Nicolaides A.N. et al. Hemispheric symptoms and carotid plaque echomorphology // J. Vasc. Surg. 2000. V. 31. P. 39-49.Seo Y., Watanabe S., Ishizu T. et al. Echolucent carotid plaques as a feature in patients with acute coronary syndrome // Circ. J. 2006. V. 70. No. 12. Р. 1629-1634.Seo Y., Watanabe S., Ishizu T. et al. Echolucent carotid plaques as a feature in patients with acute coronary syndrome // Circ. J. 2006. V. 70. No. 12. Р. 1629-1634.Bassiouny H.S., Sakaguchi Y., Mikucki S.A. et al. Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis // J. Vasc. Surg. 1997. V. 26. No. 4. P. 585-594.Bassiouny H.S., Sakaguchi Y., Mikucki S.A. et al. Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis // J. Vasc. Surg. 1997. V. 26. No. 4. P. 585-594.Hatsukami T.S., Ferguson M.S., Beach K.W. et al. Carotid plaque morphology and clinical events // Stroke. 1997. V. 28. No. 1. P. 95-100.Hatsukami T.S., Ferguson M.S., Beach K.W. et al. Carotid plaque morphology and clinical events // Stroke. 1997. V. 28. No. 1. P. 95-100.Kern R., Szabo K., Hennerici M. et al. Characterization of carotid artery plaques using real-time compound B-mode ultrasound // Stroke. 2004. V. 35. No. 4. P. 870-875.Kern R., Szabo K., Hennerici M. et al. Characterization of carotid artery plaques using real-time compound B-mode ultrasound // Stroke. 2004. V. 35. No. 4. P. 870-875.Nohara H., Shida T., Mukohara N. et al. Ultrasonic plaque density of aortic atheroma and stroke in patients undergoing on-pump coronary bypass surgery // Ann. Thorac. Cardiovasc. Surg. 2004. V. 10. No. 4. Р. 235-240.Nohara H., Shida T., Mukohara N. et al. Ultrasonic plaque density of aortic atheroma and stroke in patients undergoing on-pump coronary bypass surgery // Ann. Thorac. Cardiovasc. Surg. 2004. V. 10. No. 4. Р. 235-240.Pedro L.M., Pedro M.M., Goncalves I. et al. Computer-assisted carotid plaque analysis: characteristics of plaques associated with cerebrovascular symptoms and cerebral infarction // Eur. J. Vasc. Endovasc. Surg. 2000. V. 19. No. 2. P. 118-123.Pedro L.M., Pedro M.M., Goncalves I. et al. Computer-assisted carotid plaque analysis: characteristics of plaques associated with cerebrovascular symptoms and cerebral infarction // Eur. J. Vasc. Endovasc. Surg. 2000. V. 19. No. 2. P. 118-123.Reiter M., Effenberger I., Sabeti S. et al. Increasing carotid plaque echolucency is predictive of cardiovascular events in high-risk patients // Radiology. 2008. V. 248. No. 3. Р. 1050-1055.Reiter M., Effenberger I., Sabeti S. et al. Increasing carotid plaque echolucency is predictive of cardiovascular events in high-risk patients // Radiology. 2008. V. 248. No. 3. Р. 1050-1055.Tegos T.J., Sabetai M.M., Nicolaides A.N. et al. Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma // J. Vasc. Surg. 2001. V. 33. No. 1. P. 131-138.Tegos T.J., Sabetai M.M., Nicolaides A.N. et al. Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma // J. Vasc. Surg. 2001. V. 33. No. 1. P. 131-138.Reiter M., Horvat R., Puchner S. et al. Plaque imaging of the internal carotid artery - correlation of B-flow imaging with histopathology // Am. J. Neuroradiol. 2007. V. 28. No. 1. P. 122-126.Reiter M., Horvat R., Puchner S. et al. Plaque imaging of the internal carotid artery - correlation of B-flow imaging with histopathology // Am. J. Neuroradiol. 2007. V. 28. No. 1. P. 122-126.Carr S., Farb A., Pearce W.H. et al. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis // J. Vasc. Surg. 1996. V. 23. No. 5. P. 755-765.Carr S., Farb A., Pearce W.H. et al. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis // J. Vasc. Surg. 1996. V. 23. No. 5. P. 755-765.Aburahma A., Boland J., Robinson P., Decanio R. Antiplatelet therapy and carotid plaque hemorrhage and its clinical implications // Cardiovasc. Surg. 1990. V. 31. No. 1. Р. 66-70.Aburahma A., Boland J., Robinson P., Decanio R. Antiplatelet therapy and carotid plaque hemorrhage and its clinical implications // Cardiovasc. Surg. 1990. V. 31. No. 1. Р. 66-70.Nicholls S.C., Olson A., Moore A. et al. TCD evaluation of antiplatelet therapy for postoperative thromboembolism in carotid endarterectomy // Stroke. 2000. V. 31. Р. 323.Nicholls S.C., Olson A., Moore A. et al. TCD evaluation of antiplatelet therapy for postoperative thromboembolism in carotid endarterectomy // Stroke. 2000. V. 31. Р. 323.

The authors declare that there are no conflicts of interest present.