engleski

Stroke subtypes and frequency of carotid stenoses in patients with ischemic stroke

Objectives: It is estimated that the stenosis of the internal carotid artery is responsible for 15–20% of all ischemic strokes, which is important, since stroke is second most common cause of death in the world. Also, stroke is the main cause of acquired disability in adults, and the second most common reason for dementia. Carotid stenosis is found to be more frequent in men than in women and its prevalence to increase with age. Therefore, objectives of this study were to find out the frequency of defined degrees of carotid stenosis and the type of atherosclerotic plaques in our region. Methods: Study comprised 150 patients (77 males and 73 females) who were treated at the Neurology clinic of Clinical Hospital Center Osijek (Eastern Croatia) during the year 2011. Average age was 72.03 years (range 45-93 years). 80% of examinees in the investigated group had arterial hypertension, 26.67% had high cholesterol, 31.33% had diabetes, 28.67% had cardiomyopathy, and 27.33% had hyperuricemia. Of all patients 64% had first-ever ischemic stroke, and 34% of patients had recurrent stroke. For classification of ischemic stroke subtypes, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification was used, which comprises large vessel stroke (LVS), small vessel stroke (SVS), cardioembolic stroke (CES), stroke with other cause or etiology (OUS), and undetermined stroke (US). In all patients the diagnosis of stroke was confirmed using computed tomography ; for estimation of stenosis degree and type of atherosclerotic plaque Color Doppler Flow Imaging (ALOKA Pro-Sound SSD-5000 SV) was used. Results: According to subtypes of ischemic stroke, 43.33% of patients had SVS, 30.67% had LVS, 14% had CES, 11.33% had US and 0.6% of patients had OUS. Frequency of carotid stenosis (large-vessel cerebrovascular disease) was 18.67% (19.48% in males, and 17.81% in females). According to degree of stenosis patients were divided in 4 groups: mild stenosis (0-49%) which was presented in 10% of patients, moderate stenosis (50-69%) in 2.67% of patients, severe stenosis (70-99%) presented in 2.67% of patients, and total occlusion (100%) in 3.33% of patients. The most common type was mixed plaque (15.33%), followed by stiff plaque (13.33%), soft plaque (5.33%) and ulcerated plaque in 0.6% of cases. Conclusions: The most frequent subtype of stroke was SVS, which was expected because of high frequency of arterial hypertension and typical diet and lifestyle in continental Croatia. Relatively high frequency of atherosclerotic changes and carotid stenoses in our area corresponds to that of other countries (Switzerland, USA) ; also, it is somewhat more frequent in males. Concerning the type of plaque, there is a high frequency of mixed plaques, which is unfortunate, since they are also unstable ; hence, there is a large risk of rupture and embolism as a result.

Iscemic stroke; Stroke subtypes; Carotid stenosis

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