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Per i valori ottenuti invece sulla composizione descritta alla TCA si distinguono 2 placche calcifiche nel sesso femminile e nessuna nella controparte maschile; 1 non calcifica tra i maschi e nessuna nelle femmine; infine 7 identificate a composizione “mista” di cui 5 maschi e 2 femmine. Solo 1 rimane non descritta ed appartenente al sesso femminile.
Il confronto finale con la morfologia ex-vivo indica come si abbia in realtà 1 sola placca identificata come calcifica nel sesso femminile (nessuna tra i maschi), nessuna identificata come strettamente adiposa, 5 placche descritte come fibro-adipose (4 maschi ed 1 femmina) ed infine 5 placche fibro-calcifiche (3 femmine e 2 machi). Sono invece 2 le emorragie intraplacca evidenziate esclusivamente nel sesso maschile.
0 1 2 3 4 5 6
Calcifica Non Calcifica Mista ND
Aspetto alla TCA
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La sede di placca descritta durante l’imaging rivela come la carotide interna sia interessata in 6 maschi e 4 femmine, la carotide esterna in 1 solo caso (maschio), la biforcazione in 1 maschio e 2 femmine ed infine il bulbo su 4 maschi e 3 femmine. In 1 femmina viene indicato il solo coinvolgimento del bulbo e della biforcazione.
Per concludere l’analisi statistica del campione di asintomatici si è passati alla valutazione del volume di Calcio registrato alla TCA. I risultati sono i seguenti: la media nel sesso maschile è di 99,078 mm3 mentre nelle femmine di 203,71 mm3 ed una deviazione standard rispettivamente di 70,13 e 187,4 e senza differenza significativa. Questi
valori sono messi a confronto con la popolazione sintomatica e ne risulta che la media di Ca contenuto nella placca tra gli individui di sesso maschile sintomatici (47,128mm3) e quello contenuto nel sesso femminile (163,88mm3) è
inferiore in entrambi i casi rispetto alla controparte asintomatica.
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3.6 Conclusioni
Con il termine dell’analisi statistica effettuata dei dati raccolti ed il confronto di questi tra il gruppo di pazienti sintomatici ed asintomatici, ma anche tra sesso maschile e femminile (nel solo gruppo di asintomatici visto che risultava più bilanciato tra i due sessi) è possibile trarre alcune conclusioni.
Intanto possiamo discorrere sul potere discriminativo dell’immagine dell’ECD che indica iper-ecogene 4 placche nel gruppo asintomatico, mentre alla valutazione ex- vivo nel medesimo gruppo è descritta come calcifica solamente 1. Ovviamente l’iperecogenicità eventualmente registrata non indica con certezza la calcificazione della placca, ma indirettamente è lecito quantomeno supporlo. Lo stesso parametro valutato alla TCA mostra invece un risultato di sole 2 placche calcifiche, rendendosi quindi maggiormente preciso in questo tipo di valutazione rispetto all’ECD.
Un altro risultato invece utile è quello relativo alla misurazione del PSV. In questo contesto abbiamo registrato una media inferiore nel gruppo di asintomatici rispetto alla controparte, come era supposto da principio data la presenza di sintomi nel gruppo di confronto. Per quanto riguarda la percentuale di stenosi i dati registrati ci mostrano come la valutazione tramite TCA sia mediamente inferiore di svariati punti percentuali (nel dettaglio: 9% negli asintomatici e 11% nei sintomatici) rispetto a quella con ECD. Nell’analisi tra i due sessi dei soli pazienti asintomatici invece questa differenza rimane, ma di diversa entità: è presente uno scarto di solo il 5% nel sesso maschile, mentre del 12% nel sesso femminile.
Valutando poi il volume di Ca presente nella placca va segnalato un confronto sicuramente utile tra la media ottenuta nel gruppo di asintomatici (146mm3) e quello
di sintomatici (86mm3), come si nota la quantità è notevolmente inferiore e questo può
far anche supporre un suo ruolo giocato nello sviluppo dei sintomi. Una differenza significativa dello stesso valore si riscontra anche tra maschi e femmine del gruppo asintomatico, in cui si ha rispettivamente 99,1 e 203,7; è curioso come si evidenzi un volume di Calcio nel sesso femminile superiore alla controparte maschile anche nel gruppo di sintomatici (163,8mm3 e 47,1mm3).
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Le precedenti considerazioni supportano nel complesso quello è stato lo scopo dello studio, sebbene la popolazione analizzata non abbia certo un valore rappresentativo su larga scala. Quello che abbiamo cercato di mostrare con questa analisi è come, attualmente, un aspetto importante della diagnosi di malattia aterosclerotica come la morfologia di placca sia ancora lacunosa; ma che già ora alcune valutazioni supplementari (vedasi volume di Ca) possano essere integrate nell’iter diagnostico. Questa informazione specifica però è ovviamente ottenibile solo mediante analisi TCA e questo potrebbe essere un altro step importante, oltre alla maggior precisione nella misurazione della stenosi, a supporto di un sempre maggior utilizzo di questo metodo di imaging nella pratica clinica del chirurgo vascolare.
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