Frequency and Outcome of Carotid Atheromatous Disease in Patients With Stroke in Pakistan

Wasay, Mohammad; Azeemuddin, Muhammad; Masroor, Imrana; Sajjad, Zafar; Ahmed, Rasheed; Khealani, Bhojo A; Malik, Muhammad Ashar; Afridi, Maria B.; Kamal, Ayeesha Kamran

doi:10.1161/strokeaha.108.532960

Cited by 21 publications

(23 citation statements)

References 42 publications

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“…Almost 80% had normal studies; only 3% had >70% symptomatic carotid stenosis. These findings support previous reports of a low prevalence of carotid artery disease in Asia [23]. However, intracranial disease was common with 9% of MRAs showing focal occlusion and 24% showing focal stenosis of a large vessel.…”

Section: Discussionsupporting

confidence: 91%

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Wasay

Kaul

Menon³

et al. 2010

Cerebrovasc Dis

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Background and Objective: The objective of our study was to describe risk factors, mechanisms and outcome of young Asian women with ischemic stroke. Methods: Twelve tertiary-care centers in 8 Asian countries participated. Women aged 15–45 years were included if they had an ischemic stroke supported by neuroimaging. Data on age, risk factor history, stroke mechanism and discharge status were collected. Results: A total of 958 subjects were included, their mean age was 34 years. Large-vessel thrombosis comprised 24%, cerebral venous thrombosis 21%, cardioembolism 19% and small-vessel thrombosis 15%. The stroke risk factors included hypertension (29%), diabetes (14%), pregnancy (11%), valvular heart disease (10%) and cigarette smoking (3%). Anemia was found in 42%, and mortality was 4%; at discharge, 17% had modified Rankin score (mRS) >4 and 83% mRS 0–3. Conclusion: Unlike among Caucasians, large-vessel thrombosis, cerebral venous thrombosis and cardioembolism are common among young Asian women with stroke. A high proportion are pregnancy-related. More studies are needed.

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Section: Discussionsupporting

confidence: 91%

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Wasay

Kaul

Menon³

et al. 2010

Cerebrovasc Dis

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“…Recent systematic review and metaregression analysis of 40 studies showed 4.2% (95% CI, 3.1-5.7%) pooled prevalence of moderate stenosis; with advancing age prevalence was increasing and men were affected more often than women [15] . A recently published three-center study in Pakistan, which used a similar methodology as ours, reported a frequency of carotid disease in the same order as we found in Egypt [16] , taking into consideration that Pakistan is a transitional country like Egypt.…”

Section: Discussionsupporting

confidence: 78%

Clinical Relevance of Carotid Atherosclerosis among Egyptians: A 5-Year Retrospective Analysis of 4,733 Subjects

Abd-Allah

Baligh²,

Ibrahim³

2010

Neuroepidemiology

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Background and Purpose: The prevalence of carotid artery stenosis has been studied in several cohorts and groups of populations. Prevalence estimates were mostly based on ultrasound studies, because duplex ultrasound is accurate, reproducible and inexpensive to diagnose and follow up patients with arterial disorders. The purpose of our study was to describe the pattern of carotid artery disease in a large sample of Egyptians. Methods: We analyzed the data of 4,733 Egyptian subjects, who underwent extracranial carotid duplex scanning at the vascular laboratories of Cairo University Hospitals from January 1, 2003, to January 1, 2008. Demographic, clinical data and causes of referral were correlated with ultrasound findings. Results: Atherosclerotic carotid artery disease was present in 41% of the study population in the form of intimal thickening in 835 (17.6%), <50% stenosis in 983 (20.8%), 50–69% stenosis in 81 (1.7%), ≧70% stenosis in 38 (0.8%) and occlusion of internal carotid artery in 3 (0.06%) patients. Nonatherosclerotic disease was detected in 9 (0.2%) patients only. Significant and clinically relevant stenosis ≧50% was detected in 19 (2.5%) of the atherosclerotic symptomatic subjects. Multivariate stepwise logistic regression analysis selected age, diabetes mellitus, hypertension, smoking and dyslipidemia as independent predictors of the presence of carotid atherosclerotic disease. Conclusion: Hemodynamically significant and clinically relevant extracranial atherosclerotic carotid disease is rare among Egyptians. Risk factors for carotid atherosclerosis are the same as in societies where carotid disease is more prevalent.

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“…Lack of stroke awareness, poor access to resources, financial constraints and presentation to the hospital outside the thrombolytic window limit tPa usage [57]. From 2005 to 2007, only 18 out of 1,185 stroke patients received tPa at an academic medical center in Pakistan.…”

Section: Resultsmentioning

confidence: 99%

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

2015

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Background: Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. Summary: Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.

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Frequency and Outcome of Carotid Atheromatous Disease in Patients With Stroke in Pakistan

Cited by 21 publications

References 42 publications

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Clinical Relevance of Carotid Atherosclerosis among Egyptians: A 5-Year Retrospective Analysis of 4,733 Subjects

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

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