Frequency and risk factors of carotid artery disease among ischemic stroke patients in the south Egypt: hospital-based study

Abstract Background Limited data are available on the frequency of carotid artery disease among cerebrovascular ischemic stroke (CVS) patients in south Egypt. The aim of the present study is to determine the prevalence and risk factors of extracranial atherosclerosis among stroke patients using extracranial duplex ultrasound. Results 142 patients (76.8%) were males and 43 (23.2%) were females. Their mean age was 63.3 ± 9.79 years with no significant difference between the mean age of the male and female groups. NIHSS score ranged from 3 to 25 (mean ± S.D; 11.89 ± 4.91). 66 patients (35.7%) had no atherosclerotic changes, 75 patient (40.5%) had stenosis < 70% and 44 patients (23.8%) had stenosis ≥ 70%. The most prevalent modifiable risk factors for atherosclerosis were hypertension (74.8%), hyperlipidemia (70.6%), smoking (59.7%) and DM (45.4%). Conclusion Atherosclerosis among people in the south Egypt is relatively high in comparison to other regions in Egypt and Middle East. This is a call for performing further population-based epidemiological studies, to address the exact magnitude of the problem and invest into prevention.

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Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke

Neurosciences ◽

10.17712/nsj.2019.4.20190046 ◽

2019 ◽

Vol 24 (4) ◽

pp. 264-268 ◽

Cited By ~ 1

Author(s):

Misealreem Shaheen ◽

Areej Albelali ◽

Raghad AlKanhal ◽

Muneera AlSaqabi ◽

Raghad AlTurki ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Medical City ◽

Artery Disease

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Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke

Neurosciences ◽

10.17712/nsj.2018.4.20190046 ◽

2019 ◽

Vol 24 (4) ◽

pp. 264-268

Author(s):

Misealreem A. Shaheen ◽

Areej A. Albelali ◽

Raghad M. AlKanhal ◽

Muneera K. AlSaqabi ◽

Raghad M. AlTurki ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Medical City ◽

Artery Disease

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Spontaneous Low-Frequency Oscillations in Cerebral Vessels: Applications in Carotid Artery Disease and Ischemic Stroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2010.06.001 ◽

2010 ◽

Vol 19 (6) ◽

pp. 465-474 ◽

Cited By ~ 20

Author(s):

Henrik W. Schytz ◽

Andreas Hansson ◽

Dorte Phillip ◽

Juliette Selb ◽

David A. Boas ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Low Frequency ◽

Cerebral Vessels ◽

Low Frequency Oscillations ◽

Artery Disease

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Concomitant Surgical Treatment of Symptomatic Carotid Artery Disease With a Coexisting Shamblin I Carotid Body Tumor

Vascular and Endovascular Surgery ◽

10.1177/1538574416689430 ◽

2017 ◽

Vol 51 (2) ◽

pp. 103-107 ◽

Cited By ~ 2

Author(s):

Carlos A. Hinojosa ◽

Javier E. Anaya-Ayala ◽

Hugo Laparra-Escareno ◽

Adriana Torres-Machorro ◽

Rene Lizola ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Body ◽

Carotid Artery Disease ◽

Duplex Ultrasound ◽

Neurological Deficits ◽

Symptomatic Carotid ◽

Carotid Body Tumors ◽

Carotid Artery Endarterectomy ◽

Artery Disease ◽

Dissection Technique

Symptomatic carotid artery atherosclerotic disease is an indication for carotid artery endarterectomy. The coexistence of carotid body tumors (CBTs) with symptomatic carotid disease is rarely encountered and adds significant challenges to vascular surgeons, with a reported overall mortality for patients who undergo endarterectomy and tumor excision of 8.8%, as opposed to the 2% for those who had CBT excision only. We describe the case of a 79-year-old female who experienced an acute cerebrovascular accident in the left hemisphere; duplex ultrasound revealed high-grade carotid stenosis in the left side and the presence of a Shamblin I CBT. The risks and benefits of the planned operation were reviewed, and the decision was made to proceed with early carotid endarterectomy and concomitant surgical resection of the tumor using the retrocarotid dissection technique. The patient recovered well, and at 11 months from the combined procedure, her neurological deficits improved significantly.

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Carotid Endarterectomy for Symptomatic Carotid Artery Disease Demonstrated by Duplex Ultrasound With Minimal Arteriographic Findings

Annals of Vascular Surgery ◽

10.1007/bf02286785 ◽

1996 ◽

Vol 10 (4) ◽

pp. 385-389 ◽

Cited By ~ 6

Author(s):

Ali F. AbuRahma ◽

John F. White ◽

James P. Boland

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Disease ◽

Duplex Ultrasound ◽

Symptomatic Carotid ◽

Artery Disease

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Abstract W MP70: Characteristics of Patients With Microemboli Detected With Transcranial Doppler Monitoring

Stroke ◽

10.1161/str.45.suppl_1.wmp70 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lauren Koffman ◽

Zubair Ahmed ◽

Rebecca Michael ◽

Leasa Baus ◽

Larry Raber ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Care Center ◽

Cerebral Arteries ◽

Tertiary Care ◽

Cryptogenic Stroke ◽

Final Analysis ◽

Stroke Patients ◽

Artery Disease ◽

Wbc Count

Introduction: TCD emboli monitoring (TCDe) is a non-invasive tool used to detect the presence of ongoing microembolic signals (MES) in the intracranial arterial vessels. The clinical utility of this test in the evaluation of acute stroke patients has been debated. Our goal was to evaluate clinical factors associated with MES in ischemic stroke patients who underwent TCDe to determine which patient population may benefit from TCDe. Methods: Retrospective cohort study of adult patients admitted to our tertiary care center for TIA or ischemic stroke from 2011 to 2012 who underwent TCDe. Monitoring was performed for 20 minutes using a standardized protocol. Inclusion criteria included insonatation of both middle cerebral arteries and completion of TCD bubble study (TCB). Repeat TCDe performed on the same patient were excluded from the analysis. Demographic, clinical and objective data were collected using our EMR system. Results: Of the 113 patients included in the final analysis, mean age was 57.9 years and 46.9% were female. MES occurred in 33.6% patients. Mean # of MES was 9.3 (SD 60.6). Patients with MES were significantly younger (51.8 years vs 61.0, p.006) and had fewer vascular risk factors: diabetes (10.5% vs 33.3%, p 0.006), hyperlipidemia (23.7% vs 49.3%, p 0.007), hypertension (47.4% vs 17.33%, p 0.067), atrial fibrillation (7.9% vs 17.33 %, p 0.16), congestive heart failure (5.3% vs 10.7%, p 0.32) and coronary artery disease (18.4 % vs 29.3%, p 0.2). Cryptogenic stroke and the presence of right to left shunt (RLS) was more frequent in patients with MES than those without. Mean WBC count and usCRP were both nonsignificantly higher in patients with MES. Conclusions: Clinical characteristics of patients with MES on TCDe differed from those without MES, which may have diagnostic and clinical implications. Patients with MES were younger and had fewer stroke risk factors. MES were seen more often in patients with RLS and in those with cryptogenic stroke, which raises the possibility of an association between these two factors. Interestingly, patients with MES also had higher usCRP and WBC values, suggesting a possible inflammatory component to the occurrence of MES. More research is needed with a larger sample size to better define the significance of the above findings.

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Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Stroke ◽

10.1161/str.51.suppl_1.wp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dinesh V Jillella ◽

Sara Crawford ◽

Anne S Tang ◽

Rocio Lopez ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Regression Models ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Risk Factor Prevalence ◽

Urban Rural ◽

Artery Disease

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.

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Ischemic stroke: Observations and analysis of stroke patients admitted in a tertiary hospital of Kathmandu

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v8i2.28166 ◽

2019 ◽

Vol 8 (2) ◽

pp. 66-71

Author(s):

Dipesh Shakya ◽

Rabindra Shrestha ◽

Krishna Dhungana ◽

Raisha Kafle ◽

Sabnam Bhatta

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Artery ◽

Public Awareness ◽

Tertiary Care ◽

Care Hospital ◽

Stroke Patients ◽

Cross Sectional ◽

Carotid Artery Atherosclerosis ◽

Common Risk Factors

Background: Stroke is a disabling condition that has physical and mental impact on a patient’s life. Stroke is an important morbidity for low and middle income countries like Nepal. Hypertension, diabetes, smoking, and dyslipidemia are common risk factors in this regard and are inadequately controlled; mainly because of poor public awareness, inadequate infrastructure, lack of service and qualified manpower.Objectives: This study aims to provide insight into the epidemiology and risk factors in ischemic stroke patients.Methodology: A descriptive cross sectional study was conducted in 92 ischemic stroke patients at a tertiary care hospital Kathmandu Medical College and Teaching Hospital (KMCTH), Sinamangal, Nepal from December 2017 to June 2018. Consecutive sampling technique was used and data was collected from ischemic stroke patients above 14 years of age who were admitted in the Department of Neurology. Information regarding pre-morbid and morbid conditions, imaging findings as well as results was obtained from biochemical analysis of blood after taking consent from the patient or patient’s relative. Statistical Package for the Social Sciences Version 20 was used as a tool for statistical analysis.Results: Their mean age was 63.25 years with standard deviation of 16.45. Dyslipidemia was the most commonly found risk factor which was present in 77.2% of the subjects, followed by smoking (59.8%), presence of carotid artery atherosclerosis (59.8%), hypertension (50%), atrial fibrillation (26.1%) and diabetes mellitus(15.2%). Smoking was significant in males and heart disease was mostly seen in females.Conclusion: Dyslipidemia and smoking were the most common risk factors followed by carotid artery atherosclerosis. Patients with hypertension and dyslipidemia had higher incidence of stroke in both young and elderly group.

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Circulating Microparticles in Patients with Symptomatic Carotid Disease Are Related to Embolic Plaque Activity and Recent Cerebral Ischaemia

Cerebrovascular Diseases Extra ◽

10.1159/000495942 ◽

2019 ◽

Vol 9 (1) ◽

pp. 9-18 ◽

Cited By ~ 2

Author(s):

Neghal Kandiyil ◽

Shane T. MacSweeney ◽

Stan Heptinstall ◽

Jane May ◽

Susan C. Fox ◽

...

Keyword(s):

Carotid Artery ◽

Cerebral Ischaemia ◽

Carotid Artery Disease ◽

Transcranial Doppler Ultrasound ◽

Risk Markers ◽

Stroke Patients ◽

Symptomatic Carotid ◽

Circulating Microparticles ◽

Artery Disease ◽

Embolic Signals

Background and Purpose: In order to assess the association of microparticles derived from activated platelets (PMP) or endothelial cells (EMP) with risk markers for recurrent embolic events in patients with symptomatic carotid artery disease, we studied the associations between PMP/EMP and three risk markers: plaque haemorrhage (PH), micro-embolic signals and cerebral diffusion abnormalities. Methods: Patients with recently symptomatic high-grade carotid artery stenosis (60–99%, 42 patients, 31 men; mean age 75 ± 8 years) and 30 healthy volunteers (HV, 11 men; mean age 56 ± 12 years) were prospectively recruited. Patients were characterised by carotid magnetic resonance imaging (presence of PH [MRI PH]), brain diffusion MRI (cerebral ischaemia [DWI+]) and transcranial Doppler ultrasound (micro-embolic signals [MES+]). PMP and EMP were classified by flow cytometry and expressed as log-transformed counts per microlitre. Results: MES+ patients (n = 18) had elevated PMP (MES+ 9.61 ± 0.57) compared to HV (8.80 ± 0.73; p < 0.0001) and to MES– patients (8.55 ± 0.85; p < 0.0001). Stroke patients had elevated PMP (9.49 ± 0.64) and EMP (6.13 ± 1.0) compared to non-stroke patients (PMP 8.81 ± 0.73, p = 0.026, EMP 5.52 ± 0.65, p = 0.011) and HV (PMP 8.80 ± 0.73, p = 0.007, and EMP 5.44 ± 0.47, p = 0.006). DWI+ patients (n = 16) showed elevated PMP (DWI+ 9.53 ± 0.64; vs. HV, p = 0.002) and EMP (DWI+ 5.91 ± 0.99 vs. HV 5.44 ± 0.47; p = 0.037). Only PMP but not EMP were higher in DWI+ versus DWI– patients (8.67 ± 0.90; p = 0.002). No association was found between PMP and EMP with MRI PH. Conclusions: PMP and EMP were associated with stroke and recent cerebrovascular events (DWI+) but only PMP were also associated with ongoing (MES+) thrombo-embolic activity suggesting a differential biomarker potential for EMP to index cerebral ischaemia while PMP may predict on-going thrombo-embolic activity.

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