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.

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 ◽  
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.

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

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.

scholarly journals CAROTID ARTERY STENOSIS; IN ISCHEMIC STROKE PATIENTS

2017 ◽  
Vol 24 (08) ◽  
pp. 1126-1131
Author(s):  
MUHAMMAD ISHAQ KHATTAK ◽  
FARAMOZ KHAN ◽  
ZAHID FIDA ◽  
ADNAN ZAR
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Patients

scholarly journals Investigation of Antiphosphatidyl-Serine Antibody and Antiphosphatidyl-Inositol Antibody in Ischemic Stroke Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Hirohisa Okuma ◽  
Yasuhisa Kitagawa ◽  
Shigeharu Takagi
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Venous Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Carotid Artery Stenosis ◽  
Antiphospholipid Antibodies ◽  
Antinuclear Antibody ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Intimal Medial Thickness

Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the presence of antiphospholipid antibodies (aPL). We measured β2-GPI aCL, IgGaCL, LA, antiphosphatidyl-serine antibody (PS), and antiphosphatidyl-inositol antibody (PI) in each patient at one month after the onset of stroke. In addition, carotid artery echography was performed in patients positive for PI or PS. Among the 250 patients, 13.6% (34/250) were positive for either PI or PS, and 6.8% (17/250) were positive for both. Carotid artery echography performed on these 34 patients showed that the frequencies of increased intimal-medial thickness (IMT) of 1.1 mm or more, plaque, and carotid artery stenosis of 50% or more were all significantly higher in patients positive for antinuclear antibody than those negative for the antibody (P<.05). PI and PS are associated with antinuclear antibody and precipitation of atherosclerosis. Ischemic stroke patients with SLE frequently showed a variety of antiphospholipid-protein antibodies.

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 Cognitive Impairment: A Retrospective Study of Carotid Artery Stenosis

2019 ◽  
Vol 2 (1) ◽  
pp. 01-03
Author(s):  
M Gennaro
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Retrospective Study ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Artery Stenosis ◽  
Vascular Cognitive Impairment ◽  
Artery Stenosis ◽  
Stroke Patients

Acute ischemic stroke has been recognized as one key cause of vascular cognitive impairment (VCI). The purpose of this study was to evaluate the correlation between carotid artery stenosis and post VCI in acute ischemic stroke patients.

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