A STUDY ON CAROTID ARTERY STENOSIS AND ITS ASSOCIATION WITH RISK FACTORS IN ACUTE CEREBROVASCULAR ACCIDENTS OF ISCHEMIC ORIGIN

Abstract

Introduction: A stroke is a sudden, focal neurologic deficit lasting more than 24 hours due to being of vascular origin and is confined to an area of the brain supplied by a specific artery. Around 0.2 to 2.5 strokes per 1000 people occur annually. An ultrasound doppler is a cheap, readily available modality that can be used for early diagnosis of stroke. Thus, the study is planned to evaluate the prevalence of carotid artery stenosis in ischemic stroke patients and also to assess the predictors of carotid artery stenosis.
Materials and Methods: This is a Hospital based Prospective Cross-Sectional study. All patients were prospectively enrolled from the Acute Medical Care(AMC) and Medical wards from Department of General Medicine at SVRRGGH, Tirupati. The sample size was 100.
Patients admitted in SVRRGGH, Tirupati under the Department of General Medicine with a neurological deficit with CT /MRI evidence of acute ischemic stroke satisfying the inclusion and exclusion criteria were recruited in the study after informed consent.
Results: In our study, it is observed that 31 (31%) out of 100 study subjects were female, while 69 (69%) were males. 40% were from 53-63 years old, while only 4% were from 83- 93 years old. Mean age of the study subjects was 63.8+/-10.4 years. Seventy-two study subjects had stenosis of the carotid artery. Among them, the majority had moderate stenosis (36%), followed by mild stenosis (22%), while very few had severe stenosis (14%). Of patients with carotid artery stenosis, 72.2% had diabetes and on comparing among the study participants with carotid artery stenosis, the Chi-Square test = 4.4, p=0.02 proved a statistically significant association. Of
patients with carotid artery stenosis, 76.4% had hypertension, compared the occurrence of hypertension among the study subjects with the presence of carotid artery stenosis; the ChiSquare test = 4.99, p-value = 0.01 proved a statistically significant association between hypertension and carotid artery stenosis. In patients with carotid artery stenosis, 68% had dyslipidemia, compared among the study participants with the presence of carotid artery stenosis proved a statistically significant association by the Chi-Square test=5.38, p value=0.02. Of patients with carotid artery stenosis, 76.4% were smokers, compared among the study participants with the presence of carotid artery stenosis. Comparing the smoking status of the study participants with the 61 occurrence of carotid artery stenosis, a statistically significant association was proved by the Chi-Square test= 14.66, p value<0.001.
Conclusion : The mean age of the study subjects was 63.8+10.4 years. The prevalence of carotid artery stenosis among our study subjects was 72%. Age, diabetes, hypertension, dyslipidemia and smoking status were significant predictors of carotid artery stenosis. Among them, Diabetes (OR>1000) is the strongest predictor, followed by Smoking (OR=11.48), followed by Hypertension (OR=2.93), and dyslipidemia (OR=2.83) as the weakest predictor. Our study reiterated that the prevalence of Carotid artery stenosis is very high in patients with ischemic strokes. Carotid artery stenosis can be easily diagnosed with the help of simple, readily available, pocket-friendly investigations like ultrasound doppler. Thus, screening for carotid artery stenosis with the help of USG doppler in the high-risk group (age more than 60 years, diabetes, hypertension and dyslipidemia) would help in early diagnosis.