Extracranial Carotid Atherosclerosis and Acute Ischemic Stroke in a Tertiary Hospital in Burkina Faso

Abstract

Objective: To determine the prevalence and risk factors of carotid atherosclerosis among ischemic stroke patients in a tertiary hospital in Burkina Faso. Methodology: This was a descriptive and analytical retrospective study of patients admitted at neurology department of Yalgado Ouedraogo University Teaching Hospital with ischemic stroke and cerebral large vessel atherosclerosis in the period from January 1, 2012 to December 31, 2016. Results: The prevalence of extracranial carotid atherosclerosis was 23.9%. The mean age of patients was 63.5 years (Range 31-90 years). The study population included 65% of men and 35% of women. Hypertension was the most common vascular risk factor (75.6%). Stroke was mostly located in the anterior circulation in 23.9%. Low HDL-C was present in 52% of patients. The majority of plaque was homogeneous (85.2%). Plaque were located in carotid bulbar artery (38.5%) followed by common carotid artery (28.2%) and extracranial internal carotid artery (18.6%). According to cerebral lesion, plaque was bilateral in 45.5%, ipsilateral in 42.3% and contralateral in 12.1% of cases. Tight stenosis was found in 30.1% of patients. There was a significant link between male gender and tight stenosis (p = 0.004). Aspirin was the most antiplatelet therapy used (95.5%). Statin therapy was used in 91% of patients. The mean duration of hospitalization was 12.5 days with a mortality rate of 7.1%. Conclusions: Our study showed that extra carotid atherosclerosis was the most common cause of ischemic stroke in Burkina Faso. Man gender was most represented than women.

Incidence of Carotid Atherosclerosis in Ischemic Stroke Detected by Duplex Ultrasound

“…Among the cases with atherosclerosis in the current study, DM was detected in 17.8%. The frequency of DM in our study is similar to Dabilgou et al (20) who showed that diabetic patients represent 15.3% of the cases in their study. DM is an important risk factor for extracranial carotid atherosclerosis (16, 18, and 19) .…”

Carotid Doppler findings among patients admitted with stroke in two tertiary care facilities in Uganda: A Hospital-based Cross-sectional Study

“…In our study, the prevalence of increased CIMT was higher in participants above 60 years and age was positively associated with increased CIMT. This agrees with most global studies that show increased CIMT, carotid plaque, and carotid stenosis being more common in older people than in younger people [19][20][21]. Elevated LDL cholesterol was also associated with an increased CIMT.…”

“…Studies on the prevalence of carotid stenosis in stroke patients in Africa have yielded varying ranges of prevalence with older studies documenting absence or a very low prevalence of carotid stenosis [5,29] while the more recent studies indicate a prevalence between six to thirty percent [20]. The prevalence in this study is higher than documented by Nakibuuka et al, [26], who found no evidence of carotid stenosis as a cause of stroke a decade ago.…”

“…A positive association between CIMT and incident stroke of all types has been reported in epidemiological studies [15][16][17][18]. Several factors have been reported to be associated with an increase in CIMT including chronic use of alcohol, history of smoking, diabetes, hypertension, increase in age, elevated LDL cholesterol, male gender, among others [19][20][21][22][23][24].…”

“…This is likely to change as the population advances in age through the epidemiologic and demographic transition, increasing prevalence of hypertension [29] and without adequate risk factor prevention. The few recent studies in SSA Africa document an increasing prevalence of carotid atherosclerotic disease [20,30]. In many low-income settings, there is limited current baseline evidence of carotid atherosclerotic disease in patients admitted with stroke.…”