Role of Colour Doppler Ultrasonography of Extracranial Carotid Vessels in Ischaemic Stroke

Abstract

Stroke is classically characterized as a neurological deficit attributed to a vascular cause causing an acute focal injury of the central nervous system (CNS). Stroke is one the leading causes of disability, dementia and death worldwide. The aim of our study is to evaluate carotid arteries of stroke patients with colour doppler ultrasonography and comparison of the results of study with available literature. Material and Methods: This prospective study was approved by the Institutional ethics board and was carried out on 80 patients who presented with complaints of cerebrovascular accident to the Department of Radiodiagnosis at Kamineni Institute of Medical Sciences between June 2019 to February 2020. Written informed consent was obtained from the patients and their family members. Following a detail history and physical examination, a CT scan of the head was performed on a Toshiba Asterion 16-slice CT Imager. Patients then underwent Colour Doppler ultrasonography of bilateral extracranial vessels and all the findings were documented. Patients with hemorrhagic stroke, established carotid artery stenosis, vertebrobasilar insufficiency and those with multiple complicated carotid artery plaques were excluded. Results: 80 patients were included in the study with 61-70 years being the most commonly affected age group. Many of the patients had varying degrees of atherosclerotic and non-atherosclerotic carotid disease. 70% of the patients showed unilateral carotid plaque disease whilst 30% accounting to bilateral disease. A total of 83 plaques were evaluated for location, morphology and degree of stenosis with the most common location of the plaque was at carotid bulb in ~47% followed by 31% in CCA, 20% in ICA and 1.2% in ECA. Based on morphology, plaques were divided into 5 types. Of these Type I and Type II were the most predominant accounting to 30% and 26.5% respectively. Majority of the patients had a stenosis of <50% and severe stenosis was seen in only 15% of the patients. Conclusion: Carotid Duplex Ultrasonography still remains the first line modality of choice in evaluation of carotids despite availability of other investigations like MR or CT conventional angiography. In addition to identifying the presence of the carotid artery disease and assessing the degree of stenosis, it very useful in localization of the plaque and determining it's extent and morphological features.