Abstract WP122: Asymptomatic Moderate Carotid Artery Stenosis With Intraplaque Hemorrhage ∼ Progression of Degree of Stenosis and New Ischemic Stroke

Background: Carotid artery stenosis is one of the major causes of ischemic stroke. Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. Previous studies showed that IPH was associated with high intensity signal (HIS) on maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. Materials and Methods: We included 45 carotid plaques with moderate stenosis (50% to 69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS in carotid plaque on MIP image from routine 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS in the plaques and new ischemic strokes and annual progression rate of carotid stenosis. Results: HIS in carotid plaque was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred ipsilateral to the index carotid artery. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (6 of 21, 29%) than HIS negative group (0 of 24, 0%) (p=0.017). Annual progression rate of carotid stenosis is significantly higher in HIS positive group (+3.35%/year) than HIS negative group (-0.02%/year) (p= 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p=0.003). Conclusions: HIS in carotid plaques on 3DTOF-MRA MIP images are associated with new ischemic stroke and higher annual progression rate of stenosis. Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.

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Detection of Unstable Plaques in Patients with Carotid Stenosis Using B-Mode Ultrasonography

Interventional Neuroradiology ◽

10.1177/15910199000060s125 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 165-170 ◽

Cited By ~ 13

Author(s):

E. Kobayashi ◽

J. Ono ◽

S. Hirai ◽

I. Yamakami ◽

N. Saeki ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Heart Attack ◽

Carotid Plaque ◽

New Method ◽

Color Mapping ◽

Carotid Plaques ◽

Unstable Plaques

Distal embolism is a detrimental complication of stent placement for the carotid artery stenosis. To evaluate usefulness of B-mode ultrasonography (US) for the detection of unstable plaques in patients with carotid artery stenosis, we examined US in 46 arteries of 35 patients with carotid stenosis of >30%. The echogenicity of 46 carotid plaques was hyperechoic in 20 plaques, hypoechoic in 15, and mixed-echoic in 11. The echogenicity of carotid plaques was correlated with severity of carotid stenosis, ipsilateral stroke or T1A, heart attack, and risk factors of systemic atherosclerosis. Hypoechoic plaques were associated with severe carotid stenosis and ipsilateral ischemic event. Mixed-echoic plaques had a high incidence of past history of heart attack. Hyperechoic plaques were less likely to associate with risk factors of systemic atherosclerosis. We developed a new method of echodensity analysis. Using a computer software, echodensity values of seven plaque components were determined by comparing US findings and pathology of surgical specimens. The echodensity value was defined as a relative value to the arterial lumen. The calcified part of plaques had the highest echodensity of 6.24 ± 0.86 (mean ± 2 S.D.); fibrosis or hyarynoid degeneration of 2.05 ± 0.40, foamy histiocytes of 1.47 ± 0.05, necrosis of 1.32 ± 0.16, cholestelin clefts of 1.28 ± 0.13, intraplaque hemorrhage of 1.02 ± 0.09, and intraluminal thrombus of 1.27 ± 0.07. Constructed from the echodensity value, an echo-densitometry color mapping of the carotid plaque illustrated the exact location and extent of plaque component. B-mode US of carotid plaques represents clinical characteristics relating distal embolism and systemic atherosclerosis. A new method of echodensity analysis and echo-densitometry color mapping of the carotid plaque is useful to detect unstable plaques in patients with carotid stenosis.

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High-Intensity Signal in Carotid Plaque on Routine 3D-TOF-MRA Is a Risk Factor of Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000441094 ◽

2015 ◽

Vol 41 (1-2) ◽

pp. 13-18 ◽

Cited By ~ 6

Author(s):

Kiyofumi Yamada ◽

Masanori Kawasaki ◽

Shinichi Yoshimura ◽

Manabu Shirakawa ◽

Kazutaka Uchida ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Artery Stenosis ◽

Carotid Plaques ◽

Tof Mra ◽

The Relationship ◽

Ischemic Events

Background: Carotid atherosclerotic disease is recognized as an important risk factor for brain ischemic events. However, high-grade stenosis does not always cause ischemic strokes, whereas moderate-grade stenosis may often cause ischemic strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new cerebral ischemic events. The purpose of this study was to elucidate the relationship between high-intensity signals (HIS) on maximum intensity projection (MIP) images from routine 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and prior ischemic strokes in the patients with moderate carotid stenosis. Materials and Methods: Sixty-one patients with moderate carotid artery stenosis (50-69% stenosis based on North American Symptomatic Carotid Endarterectomy Trial criteria) were included. Carotid IPH was defined as the presence of HIS in carotid plaques on MIP images detected by 3D-TOF-MRA using criteria we previously reported. We analyzed the relationship between the presence of HIS in plaques and prior ischemic strokes defined as ischemic lesions on diffusion-weighted brain images. Results: HIS in carotid plaques were present in 27 (44%) of 61 patients. Prior ipsilateral ischemic strokes occurred more frequently in the HIS-positive group than the HIS-negative group (67 vs. 9%, p < 0.001). Furthermore, there were more smokers in the group with ischemic stroke than without it (62 vs. 25%, p = 0.005). In multivariate logistic regression analysis, HIS in carotid plaque (OR 23.4, 95% CI 4.62-118.3, p < 0.001) and smoking (OR 5.44, 95% CI 1.20-24.6, p = 0.028) were independent determinants of prior ischemic strokes after adjustment for age. Conclusions: HIS in carotid plaques on 3D-TOF-MRA MIP images are independent determinants of prior ischemic strokes in patients with moderate carotid artery stenosis, and they can potentially provide a reliable risk stratification of patients with moderate carotid artery stenosis.

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Abstract 3482: Increased Matrix Metalloproteinase-9 Expression is Correlated with Carotid Intraplaque hemorrhage in a Swine Model

Stroke ◽

10.1161/str.43.suppl_1.a3482 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Zhong-Song Shi ◽

Xiao-Bing Jiang ◽

Jin-Shan Wang ◽

Wei-Si Yuan ◽

Dong-Hong Liu

Keyword(s):

Carotid Artery ◽

Matrix Metalloproteinase ◽

Vulnerable Plaque ◽

Carotid Plaque ◽

Carotid Atherosclerosis ◽

Intraplaque Hemorrhage ◽

Swine Model ◽

Carotid Plaques ◽

Rete Mirabile ◽

Atherosclerotic Changes

Purpose: The limited number of large animal carotid atherosclerotic models restricts the preclinical evaluation of endovascular therapies. Carotid intraplaque hemorrhage may be associated with a higher risk of ischemic stroke in patients with carotid disease. In this study, we assess the association of the lesional expression of matrix metalloproteinase (MMP)-9 with vulnerable atherosclerotic carotid plaque and intraplaque hemorrhage in a Swine model. Materials and Methods: Carotid atherosclerosis was induced in miniswines using the combination of partial ligation and high cholesterol diet, and a minimum 70% stenosis was confirmed by Doppler ultrasonography immediately post-ligation. Carotid artery sections were obtained for histopathological examination and immunohistochemical study for MMP-9 at three months. Distal embolism was determined by the presence of atheroemboli in the ipsilateral rete mirabile. Atherosclerotic changes were classified by AHA/Stary stage (type I to VI). The association of distal embolism in the rete mirabile with vulnerable carotid plaque was analyzed. The association of MMP-9 expression in the plaque with the vulnerable plaque and intraplaque hemorrhage was further analyzed. Results: One hundred ninety-one carotid segments from ten carotid artery models were assessed. Among 139 segments with atherosclerotic changes, 102 segments had vulnerable plaque (Stary IV to VI). Vulnerable atherosclerotic plaques were found more frequently in the vessel wall proximal to the partial ligation than distal ( P <0.0001). Distal embolism was found in all 10 rete mirabilis, and deemed to be from the ipsilateral vulnerable carotid plaques. Areas positive for MMP-9 tended to be greater in the vulnerable plaque than in the stable plaque (8.69 ± 0.73% vs. 7.04 ± 0.94%, p=0.35). Areas positive for MMP-9 were significantly greater in the plaque with intraplaque hemorrhage than in the plaque without intraplaque hemorrhage (11.84 ± 1.22% vs. 6.63 ± 0.59%, p<0.001). On multivariate analysis, positive expression of MMP-9 was an independent predictor of intraplaque hemorrhage (p=0.007). Conclusion: Vulnerable carotid plaques with distal embolism were created in a Swine model of carotid atherosclerosis. Increased expression of MMP-9 may be associated with vulnerable carotid plaques, especially having the feature of intraplaque hemorrhage.

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Abstract TMP33: High Intensity Signal in the Plaque on 3DTOF MRA is Associated With Ischemic Stroke in the Patients With Low Grade Carotid Artery Stenosis

Stroke ◽

10.1161/str.48.suppl_1.tmp33 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kiyofumi Yamada ◽

Masanori Kawasaki ◽

Shigehiro Nakahara ◽

Yoshikazu Sato ◽

Kazutaka Uchida ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

High Intensity ◽

Odds Ratio ◽

Artery Stenosis ◽

Low Grade ◽

Carotid Plaques ◽

Tof Mra ◽

High Intensity Signal

Background: Carotid artery stenosis is one of the major causes of ischemic strokes. However, degree of stenosis is not always correlated with frequency of ischemic strokes. Recently, it was reported that carotid intraplaque hemorrhage (IPH) was associated with accelerated plaque growth, luminal narrowing and development of symptomatic events. Maximum intensity projection (MIP) images are easily reformatted within from 5 minute, routine time-of-flight (TOF) sequences. The aim of this study was to evaluate the relationships between high intensity signal (HIS) in the carotid plaques on MIP images detected by routine three-dimensional TOF magnetic resonance angiography (3D-TOF MRA) and ischemic strokes. Materials and Methods: One hundred fifty two patients with low-grade carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria: 30% - 49%) were included. IPH was defined as the presence of HIS in the carotid plaques on MIP images of 3D-TOF MRA using the previously reported criteria. We analyzed the relationship between the presence of HIS in the plaques and prior ischemic strokes defined as ischemic lesions on diffusion weighed images of the brain. Results: HIS in the carotid plaque was present in 56 (37%) of 152 carotid arteries. Prior ipsilateral ischemic strokes were observed more frequently in HIS-positive group (12 of 56, 21.4%) than HIS-negative group (1 of 34: 2.9%) [p<0.001]. In multivariate logistic regression analysis, HIS (Odds ratio: 77.7, 95%CI: 6.4 - 944.0, p<0.001) and diabetes mellitus type 2 (odds ratio: 10.45, 95%CI: 1.6 - 67.9, p=0.014) were independent determinants of prior ischemic strokes after adjustment for age. Conclusions: HIS in the carotid plaques on MIP images of 3D-TOF MRA was an independent determinant of prior ischemic stroke in patients with low-grade carotid artery stenosis, and this finding may provide a reliable risk stratification of future stroke in patients with low-grade carotid artery stenosis.

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Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Cerebrovascular Diseases ◽

10.1159/000506826 ◽

2020 ◽

Vol 49 (2) ◽

pp. 200-205

Author(s):

Juha-Pekka Pienimäki ◽

Niko Sillanpää ◽

Pasi Jolma ◽

Sara Protto

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Clinical Outcome ◽

Acute Stroke ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Collateral Circulation ◽

Artery Stenosis ◽

Stroke Patients ◽

Significant Difference

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

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Abstract TMP44: Contrast Enhanced Ultrasound Can Detect Small Disruption of Carotid Plaques Related to Symptomatic Internal Carotid Artery Stenosis

Stroke ◽

10.1161/str.47.suppl_1.tmp44 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Soichiro Abe ◽

Kozue Saito ◽

Hatsue Ishibashi-Ueda ◽

Shuichi Tonomura ◽

Kota Mori ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Internal Carotid ◽

Color Doppler ◽

Internal Carotid Artery Stenosis ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

Background: The ulcerated atheroma of the carotid artery is a risk factor of ipsilateral ischemic stroke. Contrast-enhanced ultrasound (CEUS) is a novel noninvasive technique useful for evaluating the morphology of carotid plaques, and can detect small disruptions on plaque surface. However, it remains unclear whether the disrupted carotid plaque detected by CEUS is related to the symptomatic internal carotid artery stenosis (ICS). Methods: A total of 79 ICS patients who underwent carotid endarterectomy (CEA) were enrolled from July 2010 to July 2015. Before operation, ICA lesions were examined by color Doppler ultrasound (CDUS) and CEUS using perflubutane. The ulceration was diagnosed when both of the color Doppler signal on CDUS and the pooling of microbubbles on CEUS were observed within the plaque. The disruption was diagnosed only by CEUS when microbubbles pooled through the fissured surface, unlike the linear delineation of neovessels. We validated findings on ultrasound compared with the histopathological findings of ulceration and present/recent plaque rupture. The associations between ulceration/disruption on ultrasound and symptomatic ICS (with a history of ipsilateral transient ischemic attack and/or ischemic stroke) were investigated. Results: Of 79 subjects (mean age 71.2±6.8 years old, 78 men), 55 had symptomatic ICS. The ulceration by CEUS and CDUS was recognized in 20 patients (25%), and the disruption on plaque surface was seen by CEUS solitary in 26 patients (33%). The sensitivity and specificity of detecting plaque ulceration or disruption using CEUS compared with histopathological findings were 0.57 (45/66) and 1.00 (13/13), respectively. The detection rate of ulceration or disruption using CEUS was higher in symptomatic ICS than in asymptomatic ICS (66% vs 42%, P=0.049). Compared to plaques without ulceration/disruption on ultrasound, prevalence of symptomatic ICS was higher in plaques with the disruption (88% vs 58%, P=0.01), whereas it was similar in plaques with the ulceration (65% vs 58%, P=0.77) Conclusion: Small disruptions on carotid plaque surface detected by CEUS were significantly related to symptomatic ICS and this results may help the detailed assessment of plaque vulnerability.

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Ischemic stroke secondary to self-inflicted carotid sinus massage: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02680-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Edgar R. Lopez-Navarro ◽

Götz Greif ◽

Carl-Albrecht Haensch ◽

Adrian Ringelstein ◽

Robert Larbig

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Stroke Unit ◽

Carotid Sinus ◽

White Male ◽

Magnetic Resonance Images ◽

Artery Stenosis ◽

Carotid Sinus Massage

Abstract Background The risk of stroke after carotid sinus massage is greater if there is preexisting carotid stenosis or carotid plaques. We present the case of a patient with underlying 40% carotid stenosis, who developed a watershed stroke after a self-neck massage in our stroke unit. We show a well-documented case with magnetic resonance images before and after the neck massage. We report a case of a watershed brain infarct after a self-massage of the carotid sinus, with preexisting carotid artery stenosis. Neck massage continues to be a significant cause of stroke and should therefore not be performed by patients. Clinicians must be aware of the implications of a carotid sinus massage in both the outpatient and inpatient settings. Case presentation We admitted a 58-year-old white male patient, with no relevant medical history, to our department with a brain stem infarct. During his stay at our stroke unit, the patient performed a self-neck massage with consecutive bradycardia and asystole, resulting in left-side hemiparesis. The underlying cause of the hemodynamic stroke is believed to be secondary to this intensive neck massage performed by the patient. The patient also suffered from unknown right internal carotid artery stenosis. Conclusion Clinicians and patients must be aware that neck massage can lead to ischemic stroke. We postulate that repetitive impaired cardiac output can lead to a hemodynamic (watershed-type) stroke.

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Association between Circulatory and Plaque Resistin Levels with Carotid Plaque Instability and Ischemic Stroke Events

The Heart Surgery Forum ◽

10.1532/hsf.2071 ◽

2018 ◽

Vol 21 (6) ◽

pp. E448-E463

Author(s):

Ivana Jurin ◽

Frane Paić ◽

Stela Bulimbašić ◽

Igor Rudež ◽

Lovorka Đerek ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

High Grade ◽

Plaque Vulnerability ◽

Histological Features ◽

Plaque Instability

ses of ischemic stroke. The risk of ischemic stroke increases with the degree of carotid stenosis and plaque vulnerability. The aim of this study was to investigate the association of circulating and plaque resistin levels with plaque vulnerability and ischemic stroke events in patients with moderate- to high-grade carotid artery stenosis. Methods: 40 patients with ischemic stroke events and 38 neurologically asymptomatic patients scheduled for carotid endarterectomy were recruited for this study. Fasting blood samples for laboratory analysis were collected preoperatively and serum resistin levels were measured by enzyme-linked immunosorbent assays. Carotid endarterectomy specimens were analyzed according to the gold-standard procedure of histological classification. Plaque resistin expression was determined by standard immunohistochemical procedure. Results: Serum resistin levels and resistin plaque expression were found to be significantly higher in subjects with unstable carotid plaque (P < .001) while significantly higher serum resistin levels were also present in patients with ischemic stroke events (P < .001). In univariate stepwise logistic regression analysis, higher serum resistin levels were significantly associated with plaque instability (OR 2.223, 95% CI 1.488-3.320, P < .0001) and ischemic stroke events (OR 1.237, 95% CI 1.079-1.420, P = .002). There was also a significant association between higher serum and plaque resistin expression (OR 1.663, 95% CI1.332-2.077, P < .0001). These associations remained significant in all models of multivariate logistic regression analysis. High serum and plaque resistin levels were also significantly associated with specific histological features of plaque instability. Conclusion: The results suggests that serum resistin levels may be used as a potential biomarker of plaque vulnerability and ischemic stroke events in patients with moderate- to high-grade carotid artery stenosis and highlight the possible relationship that plaque resistin expression has with histological features of plaque vulnerability.

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Carotid Artery Plaque Calcifications: Lessons From Histopathology to Diagnostic Imaging

Stroke ◽

10.1161/strokeaha.121.035692 ◽

2021 ◽

Author(s):

Luca Saba ◽

Valentina Nardi ◽

Riccardo Cau ◽

Ajay Gupta ◽

Hooman Kamel ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Plaque ◽

Intraplaque Hemorrhage ◽

Calcium Deposition ◽

Carotid Artery Plaque ◽

Carotid Plaques ◽

Novel Technologies ◽

Carotid Artery Calcification ◽

Wide Range

The role of calcium in atherosclerosis is controversial and the relationship between vascular calcification and plaque vulnerability is not fully understood. Although calcifications are present in ≈50% to 60% of carotid plaques, their association with cerebrovascular ischemic events remains unclear. In this review, we summarize current understanding of carotid plaque calcification. We outline the role of calcium in atherosclerotic carotid disease by analyzing laboratory studies and histopathologic studies, as well as imaging findings to understand clinical implications of carotid artery calcifications. Differences in mechanism of calcium deposition express themselves into a wide range of calcification phenotypes in carotid plaques. Some patterns, such as rim calcification, are suggestive of plaques with inflammatory activity with leakage of the vasa vasourm and intraplaque hemorrhage. Other patterns such as dense, nodular calcifications may confer greater mechanical stability to the plaque and reduce the risk of embolization for a given degree of plaque size and luminal stenosis. Various distributions and patterns of carotid plaque calcification, often influenced by the underlying systemic pathological condition, have a different role in affecting plaque stability. Modern imaging techniques afford multiple approaches to assess geometry, pattern of distribution, size, and composition of carotid artery calcifications. Future investigations with these novel technologies will further improve our understanding of carotid artery calcification and will play an important role in understanding and minimizing stroke risk in patients with carotid plaques.

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Duplex Study of Carotid Artery in Patients with Ischemic Stroke

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v28i2.17172 ◽

2013 ◽

Vol 28 (2) ◽

pp. 67-73

Author(s):

Nasreen Sultana ◽

AKM Faslul Bari ◽

Touhidul Karim Majumder ◽

Md Rafiqul Islam ◽

Ferdous Ara Hossain

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Total Occlusion ◽

Ischemic Lesion ◽

Significant Stenosis

Objective: To determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients. Method: It was cross-sectional observational study which was carried out in neurology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of January 2010 to December 2011 and one hundred patients admitted with acute ischemic stroke were included in the study. Doppler ultrasound was performed during hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS - 14. Results: Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% ( n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found to have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion and 19% (n=11) had stenosis on the contralateral side. Out of significant stenosis ,mild (50% stenosis) in 12% (n=7) patients, moderate ( 51-69% ) stenosis in 50%( n= 30 ) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Conclusion: Carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke.DOI: http://dx.doi.org/10.3329/bjn.v28i2.17172 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 67-73

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