Contribution of Doppler Ultrasound of the Supra-Aortic Trunks in the Etiological Evaluation of Ischemic Strokes at the Douala General Hospital

Abstract

Introduction: The advent of Doppler ultrasound has revolutionized the diagnosis of even subclinical atherosclerosis of the neck vessels. The aim of this study was to evaluate the contribution of Doppler ultrasound of the supra-aortic trunks in the etiological evaluation of ischemic stroke. Methods: Our cross-sectional and analytical study with retrospective and prospective data collection more than 8 years from January 1, 2010, to December 31, 2017, involved patients aged at least 21 years who were hospitalized for ischemic stroke. Doppler ultrasound of the supra-aortic trunks allowed us to group carotid atherosclerotic plaques into 5 grades according to the Gray-Weal classification modified by Geroulakos. Similarly, we assessed the degree of carotid stenosis in these patients. Factors associated with atherosclerotic plaques and stenosis were determined using multivariate logistic regression. Associations with a P < 0.1 in univariate regression were included in the multivariate model. Differences were considered significant for P < .05. Results: We recruited 271 patients with a mean age of 60 ± 12 years. Hypertension, increased low-density lipoprotein, diabetes, smoking, and obesity were present in 76.8%, 74.7%, 36.5%, 9.6%, and 80.1%, respectively. Atherosclerotic carotid plaques were found in 76.0% of the patients. For the left carotid artery, Grade I, II, and III plaques were present in 32.4%, 30.5%, and 21.4% of these patients, respectively, and the results were similar in the right carotid artery. Age ≥60 years, female gender, and increased low-density lipoprotein were significantly associated with carotid atherosclerosis (odds ratio = 12.6, P = .003; odds ratio = 3.23, P = .001; and odds ratio = 4, P = .002, respectively). Carotid stenosis ≥50% was found in 5.9% of patients with plaque, and age >70 years was significantly associated with these stenoses (odds ratio = 4.74, P = .045). Conclusion: Our study showed a high prevalence of atherosclerotic carotid plaques (76.0%) and stenosis (5.9%) among patients with ischemic strokes who had Doppler ultrasound of the neck vessels. Age is a powerful risk factor associated with carotid atherosclerosis and stenosis. Female gender and dyslipidemia are also significantly associated with carotid atherosclerotic plaques.