The Significance of the Ultrasound Parameters of Carotid Artery Atherosclerosis in Neuroangiosurgical Practice

Abstract

The Significance of the Ultrasound Parameters of Carotid Artery Atherosclerosis in Neuroangiosurgical Practice Introduction. Atherosclerosis of the extracranial part of the cerebral arteries is a major pathogenetic risk factor of cerebral infarction (CI) and transitory ischemic attacks (TIA). An ischemic stroke is one of the leading causes of death and long-term disability in many developed countries and is a condition that becomes more prevalent with age. Aim of the study. To define the diagnostic implications of the US examinations of the extracranial part of the carotid arteries in respect of neurological practice and taking into consideration the age, gender and the localisation of the ischemic damage of patients with atherothrombotic MCA infarction. Materials and methods. 540 patients treated in the Stroke Unit of Gailezers University Clinic who were diagnosed as having a first MCA infarction of atherothrombotic genesis in the acute phase were examined. The patients were 36 to 91 and were divided into 6 age groups. The group of patients examined comprised of 267 people - 49.4%- females and 273 - 50.6% - males. US examinations of the carotid arteries were performed with a high resolution Philips iU22 ultrasonographic device with a multifrequency linear probe of 3.0 to 9.0 MHz. Results. The ultrasonologic parameters of the carotid artery atherosclerosis in patients with first atherothrombotic infarction of MCA revealed that 70.8% were aged between 60 to 79. This indicated that the risk of atherotrombotic MCA infarction was highest in this age group and this needs to be taken into account in angiosurgical practice. The largest number of women - 50.6% - with an MCA infarction were in the 70 to 79 age group but the largest number of men - 41.0% were found in the 60 to 69 age group. In patients with a first MCA infarction stable carotid artery plaques with lumen stenosis of less than 50% in the age group below 59 were found in 47.2% of cases among other parameters, i.e. 7.4% more frequently than in the age group from 60 to 79 (p<0.1) and 11.8% more than in the age group above 79 (p<0.05). The frequency of carotid artery extracranial segment stenosis of less than 50% did not differ significantly in different age groups and was 12.6% on average. Occlusion as a delayed pathogenetic risk factor of atherotrombotic infarction was observed in 62 - 11.5% - of patients. In a large number of patients, 34.3% on average, unstable plaques with an uneven surface, ruptures, craters, wall thrombosis and with hemorrhages were found less frequently. This frequency increased significantly with age. There was frequent evidence of the localization of carotid artery atherosclerotic lesions in relation to the locality of CI to be bilateral as well as heterolateral. Conclusion. To diagnose atherosclerotic lesions of the carotid artery and to confirm indications of surgical and pharmaceutical therapy more statistically significant information needs to be obtained through specialized neuroangio-US examinations.