Carotid Doppler in Evaluation of a cute Cerebral Stroke and its Correlation with Computed Tomography of Brain

Abstract

Introduction: Stroke can be defined as an acute central nervous system injury with an abrupt onset. Acute ischemia constitutes approximately 80% of all strokes and is an important cause of morbidity and mortality.Carotid doppler ultrasonography remains the main stay for the evaluation of extracranial carotid vessels. It has well established good accuracy in comparison with angiography studies. Besides estimating the degree of stenosis, the biggest advantage of sonography is its ability to identify and characterize plaque and identify plaques with higher risk of embolization with the use of high resolution ultrasound. Objective: To evaluate stroke patients with carotid ultrasound for : The thickness of intima-media Presence of plaque and its characterization Analysis of spectral waveforms in extracranial carotid vessels Estimation of percentage of stenosis To establish a correlation between the percentage of stenosis and type of infarct on CT brain.To establish a correlation between type, site of plaque, and risk of infarction in patients of stroke. Materials and Methods: This was a prospective observational study done for a Two year period from November 2017 to October 2019.Present study was undertaken after approval from hospital ethical committee. In this prospective study, 50 patients with symptoms of acute cerebral stroke referred for CT imaging and carotid doppler were included in the study. This study was carried out in patients who had symptoms and signs of acute cerebral stroke at our institute. The patients underwent computed tomography (CT) scan study prior to the color Doppler sonography of carotid arteries and findings were documented. Patients with symptoms of stroke and transient ischemic attack such as sudden loss of consciousness, altered sensorium, aphasia, slurring of speech, diminution or loss of vision. The data gathered from the colour doppler examination consisted of Peak Systolic velocity of common carotid artery Peak systolic velocity of internal carotid artery Velocity ratios between Internal carotid artery and common carotid arteries. Plaque characteristics as seen on the real time image. The presence of Spectral broadening. All the examination was performed with a Doppler angle of 60 degrees Colour Doppler examination of the carotid arteries was done using images from Philips affinity 50G ultrasound machine with probe frequency of 5-12 MHZ in department of Radiodiagnosis from November 2017. CT examination was performed on multidetector 16 Slice CT Siemens Somatom Emotion. Results: Fifty patients with symptoms of acute anterior cerebral stroke were included in this study. Patients with symptoms of posterior circulatory stroke were excluded from the study. This study is a prospective cross-sectional study. Males were more commonly affected than females. Most of the patients in this study come under the age group of 60-69 years. Right-sided involvement was noted in 56%, left sided involvement was noted in 38%,and bilateral involvement was noted in 6% of cases.The mean intima-media thickness was 1.246 mm. The thickness of the intima-media was more in higher age groups, indicating the progress of atherosclerosis with age. Majority of the patients had 40-59% of stenosis. The most common type of plaque noted in this study is a completely echogenic plaque, i.e.homogenous plaque.Large-sized cortical infarcts were most common during the study. There was a significant correlation between the type of plaque and the percentage of stenosis. Completely echogenic plaque is associated with a higher percentage of stenosis. There was a significant correlation between the location of the plaque and the risk of infarction.Carotid doppler has an overall sensitivity of 84% in cerebrovascular stroke patients. Conclusion: Color Doppler examination is a non invasive, economical, safe, reproducible, and less time-consuming method of demonstrating the cause of cerebrovascular insufficiency in the extracranial carotid arterial system and will guide in instituting the treatment.In this study, there was a significant association between the size of infarct in CT Brain and the amount of stenosis in Internal Carotid Artery on color doppler. There was also a significant association between the size of infarct in CT Brain and the amount of stenosis in ICA on color doppler. There was a high prevalence of carotid artery disease, as evidenced by increased intima-media thickness, plaques, and significant stenosis of internal carotid arteries in patients with stroke in this study. This study highlights the significance of the doppler ultrasonography in this stroke prevention effort through the surveillance of atherosclerosis, which can predispose a person to cerebral ischemia.