Early ultrasound imaging of carotid arteries in the acute ischemic cerebrovascular patients

Role of imaging in early diagnosis of acute ischemic stroke: a literature review

Stroke is a serious health condition that is responsible for more than 5% of total deaths. Near 20% of patients experiencing stroke die every year, resulting in the stroke being at the top of the list of preventable causes of death. Once an acute stroke is suspected, a golden hour of less than an hour is available to prevent the undesirable consequences. Since neuroimaging is mandatory in the diagnosis of stroke, the proper use of neuroimaging could help saving time and planning the right treatment for the patient. Some of the available imaging methods help us with rapid results, while others benefit us from a more accurate diagnosis. Hereby, we aim to provide a clinical review of the advantages and disadvantages of different available neuroimaging methods in approaching acute stroke to help clinicians choose the best method according to the settings.

Extracranial Carotid Artery Disease: Risk Factors and Outcomes in Patients With Acute Critical Hemispheric Ischemic Stroke

OBJECTIVES

The prevalence of carotid disease in stroke patients has been underestimated because most stroke patients who receive carotid sonography have already survived the acute event. Little is known about the extracranial carotid arteries of patients with acute stroke who need intensive care. This study reviewed color-coded carotid duplex sonographic examinations of the extracranial carotid arteries of patients with acute critical hemispheric ischemic stroke.

METHODS

We retrospectively reviewed 30 consecutive patients who had acute critical hemispheric ischemic stroke and received color-coded carotid duplex sonography in the intensive care unit. The presence of occlusive carotid artery disease was correlated with clinical features, vascular risk factors, and outcomes.

RESULTS

Overall, 57% of the patients (17 of 30) had an occlusive internal carotid artery, and 44% of patients with atrial fibrillation (7 of 16) also had occlusive carotid disease. Eventually, 73% of the patients (21 of 30) had poor outcomes, and 57% (17 of 30) died. The contributing factors to a poor outcome were older age, an initial conscious disturbance, endotracheal intubation, and occlusive carotid disease, with the most significant factor being older age (P = .022; odds ratio, 27.76). The factors contributing to death were endotracheal intubation, occlusive carotid disease, and reversed ophthalmic flow, with the most significant factor being occlusive carotid disease (P = .014; odds ratio, 11.38). Soft homogeneously echogenic thrombi filling the lumen of the internal carotid artery and moving forward and backward with the carotid pulse were found in 3 patients. A small segment of ruptured plaque that was floating forward and backward with pulsation was found in 1 patient.

CONCLUSIONS

Occlusive carotid artery disease is not uncommon among Chinese patients who have had an acute critical hemispheric infarction. Older age is the factor most significantly correlated with a poor outcome, and occlusive carotid disease is the factor most significantly correlated with death.