scholarly journals Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. C. D. Mettananda ◽  
M. D. P. Eshani ◽  
L. M. Wettasinghe ◽  
S. Somaratne ◽  
Y. P. Nanayakkkara ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Doppler Ultrasonography ◽  
Sri Lankan ◽  
Stroke Patients ◽  
Total Occlusion ◽  
Carotid Doppler

Abstract Background Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. Results A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. Conclusions Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.

scholarly journals A STUDY ON PREVALENCE OF CAROTID ARTERY STENOSIS IN ACUTE ISCHAEMIC STROKE PATIENTS

2016 ◽  
Vol 5 (103) ◽  
pp. 7559-7565
Author(s):  
Kamatchi Karunanidhi ◽  
Dhurgesa Nanthini Vijaya Sundaram ◽  
Murugarajan Singaram
Keyword(s):  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Patients

A Study on First Ischaemic Stroke Patients for Prevalence of Extracranial Carotid Artery Stenosis and Risk Factors: Our Experience in Northeast India and Review of Literature

2020 ◽  
pp. 875647932096916
Author(s):  
Prabuddha J. Das ◽  
Sanjeev K. Handique ◽  
Baijayanta Saharia
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Carotid Artery Stenosis ◽  
Northeast India ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Focal Neurological Deficit ◽  
Extracranial Carotid Artery ◽  
High Prevalence

Objective: To assess the prevalence of carotid artery stenosis and risk factors in stroke patients of northeast India. This is a prospective hospital-based study on 157 first ischaemic stroke patients of the region. Method: A total of 157 patients presenting with first ever sudden onset focal neurological deficit lasting for more than 24 hours due to acute ischaemic brain infarction were selected, after excluding other causes of focal neurological deficit by imaging. All extracranial carotid arteries were evaluated with carotid ultrasonography. Forty-four patients also had computed tomography (CT) angiography of intracranial and extracranial arteries. Risk factors of stroke were recorded for each patient. Results: Only 8.92% patients had significant extracranial carotid artery stenosis. There was high prevalence of intracranial artery stenosis compared to extracranial artery stenosis in patients who had CT angiography. There was high prevalence of hypertension, dyslipidemia, and diabetes. Increased age and male sex were important factors associated with first ischaemic stroke. Conclusion: The prevalence of significant extracranial carotid artery stenosis is low in northeast Indian patients with first ischaemic stroke, indicating that it is not a major cause of ischaemic stroke in this population. There may be high prevalence of intracranial artery stenosis compared to extracranial artery stenosis.

scholarly journals Association of extracranial carotid artery stenosis in ischemic stroke in a Sri Lankan cohort of patients - An analytical cross-sectional study

2021 ◽  
Author(s):  
Ishani Rajapakshe ◽  
Devasmitha Wijesundara ◽  
Amila Chandrakumara ◽  
Bimsara Senanayake
Keyword(s):  
Ischemic Stroke ◽  
Sri Lanka ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Low Grade ◽  
Ageing Population ◽  
Sri Lankan ◽  
Stroke Patients ◽  
Extracranial Carotid Artery

Abstract Background and Objectives : The burden of stroke in Sri Lanka is on the increase with the current demographic transition toward an ageing population [1]. However, the association of symptomatic extracranial carotid artery stenosis (CAS) in ischemic stroke has not been prospectively evaluated in a Sri Lankan cohort of patients. Globally population-based studies have estimated about 15% of ischemic strokes are caused by large vessel occlusions. It is commonly believed that the prevalence of significant extracranial CAS is low in Sri Lanka compared to western populations [2, 3]. The purpose of the study is to systematically analyses and assess this long held notion and to search for other associated causative factors. Methods The study population comprised 164 acute ischemic stroke patients admitted to the National hospital of Sri Lanka over a period of 3 months. Carotid artery duplex scans were done by a single well-trained operator within 2 weeks of presentation and degree of CAS was classified as low (< 50%), moderate (50–69%), severe (> 70%) and complete occlusion according to NASCET criteria. Factors associated with CAS were identified by stepwise multiple logistic regression analysis. Results Out of 164 ischemic stroke patients 104 (63.4%) were male and 60 (36.6%) were female. The mean age of stroke patients was 62.2+- 14.21 years. 139 (84.8%) had low grade stenosis, 10 (6.1%) had moderate stenosis, 7 (4.2%) had severe stenosis and 8 (4.9%) had complete stenosis of carotid artery. Older age and presence of previous TIAs were significantly associated with CAS. Gender, hypertension, diabetes mellitus, hypercholesterolemia, IHD, previous stroke, previous TIA, previous use of antiplatelets, family history of stroke, previous use of statins and presence of carotid bruit were not significantly associated. Conclusion Extracranial carotid artery occlusion previously considered a rare cause of ischemic stroke in Sri Lanka was found to be having a prevalence similar to western populations in this study with over 15% having significant stenosis. Hence, we emphasize that early carotid doppler studies must be performed in all ischemic strokes at least within two weeks and necessary interventions carried out where it is deemed necessary.

Carotid endarterectomy: neither shunting nor patching technique

2018 ◽  
Vol 26 (6) ◽  
pp. 446-450 ◽  
Author(s):  
Aram Baram ◽  
Goran Majeed ◽  
Allaa Subhi Abdel-Majeed
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Primary Closure ◽  
Artery Stenosis ◽  
Safe Procedure ◽  
Total Occlusion ◽  
Patch Angioplasty ◽  
Bilateral Carotid

Introduction The role of carotid shunting in carotid endarterectomy is controversial. Many studies have concluded that patch angioplasty is preferable to primary closure, while others found that it had no value. The aim of this study was to report the results of our first series of patients undergoing carotid endarterectomy with a non-shunting technique and primary closure of the arteriotomy. Methods From October 2014 to October 2017, 63 patients with unilateral or bilateral carotid artery stenosis underwent carotid endarterectomy. There were 48 males and 15 females, the mean age was 63.16 years, and all were symptomatic. Conventional endarterectomy was performed without a shunt in all cases. All arteriotomies were closed primarily. We analysed the early and late outcomes of this procedure with at least 18 months of follow-up. Results Diabetes was the most frequent comorbidity. Most of the patients had a history of transient ischemic attack (49.2%) or stroke (44.4%). All patients had significant (moderate to severe) carotid artery stenosis. Postoperatively, 2 (3.2%) patients developed ischemic stroke, one (1.6%) suffered hypoglossal nerve injury, and one had a postoperative cervical hematoma. During follow-up, one patient developed asymptomatic total occlusion of the endartrectomized carotid artery at 18 months. Conclusion Carotid endarterectomy without shunting is a safe procedure. The short- and longer-term outcomes are not significantly inferior to those of the routine or selective shunting technique, and the rate of restenosis is not higher than that of patch angioplasty closure.

Sign in / Sign up

Export Citation Format

Share Document