Skip to main content
Top
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery 1/2021

Open Access 01-12-2021 | Arterial Occlusive Disease | Research

Frequency and risk factors of carotid artery disease among ischemic stroke patients in the south Egypt: hospital-based study

Authors: Eman Khedr, Abeer A. Tony, Mohamed Habeel, Ahmed Nasreldein

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Login to get access

Abstract

Background

Limited data are available on the frequency of carotid artery disease among cerebrovascular ischemic stroke (CVS) patients in south Egypt. The aim of the present study is to determine the prevalence and risk factors of extracranial atherosclerosis among stroke patients using extracranial duplex ultrasound.

Results

142 patients (76.8%) were males and 43 (23.2%) were females. Their mean age was 63.3 ± 9.79 years with no significant difference between the mean age of the male and female groups. NIHSS score ranged from 3 to 25 (mean ± S.D; 11.89 ± 4.91). 66 patients (35.7%) had no atherosclerotic changes, 75 patient (40.5%) had stenosis < 70% and 44 patients (23.8%) had stenosis ≥ 70%. The most prevalent modifiable risk factors for atherosclerosis were hypertension (74.8%), hyperlipidemia (70.6%), smoking (59.7%) and DM (45.4%).

Conclusion

Atherosclerosis among people in the south Egypt is relatively high in comparison to other regions in Egypt and Middle East. This is a call for performing further population-based epidemiological studies, to address the exact magnitude of the problem and invest into prevention.
Literature
1.
go back to reference DALYs GBD, Collaborators H. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859–922.CrossRef DALYs GBD, Collaborators H. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859–922.CrossRef
2.
go back to reference Collaborators GBDN. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459–80.CrossRef Collaborators GBDN. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459–80.CrossRef
3.
go back to reference Abd-Allah F, Khedr E, Oraby MI, Bedair AS, Georgy SS, Moustafa RR. Stroke burden in Egypt: data from five epidemiological studies. Int J Neurosci. 2018;128(8):765–71.CrossRef Abd-Allah F, Khedr E, Oraby MI, Bedair AS, Georgy SS, Moustafa RR. Stroke burden in Egypt: data from five epidemiological studies. Int J Neurosci. 2018;128(8):765–71.CrossRef
4.
go back to reference Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol. 1999;26(7):563–5.CrossRef Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol. 1999;26(7):563–5.CrossRef
5.
go back to reference Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D. Racial differences in the distribution of anterior circulation occlusive disease. Neurology. 1984;34(1):54–9.CrossRef Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D. Racial differences in the distribution of anterior circulation occlusive disease. Neurology. 1984;34(1):54–9.CrossRef
6.
go back to reference Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001;32(11):2559–66.CrossRef Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001;32(11):2559–66.CrossRef
7.
go back to reference Jahromi AS, Cina CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2005;41(6):962–72.CrossRef Jahromi AS, Cina CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2005;41(6):962–72.CrossRef
8.
go back to reference Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89.CrossRef Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89.CrossRef
9.
go back to reference Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRef Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRef
10.
go back to reference American Diabetes A. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14–31.CrossRef American Diabetes A. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14–31.CrossRef
11.
go back to reference Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229(2):340–6.CrossRef Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229(2):340–6.CrossRef
12.
go back to reference Abd Allah F, Baligh E, Ibrahim M. Clinical relevance of carotid atherosclerosis among Egyptians: a 5-year retrospective analysis of 4733 subjects. Neuroepidemiology. 2010;35(4):275–9.CrossRef Abd Allah F, Baligh E, Ibrahim M. Clinical relevance of carotid atherosclerosis among Egyptians: a 5-year retrospective analysis of 4733 subjects. Neuroepidemiology. 2010;35(4):275–9.CrossRef
13.
go back to reference Saber H, Amiri A, Thrift AG, Stranges S, Bavarsad Shahripour R, Farzadfard MT, et al. Epidemiology of intracranial and extracranial large artery stenosis in a population-based study of stroke in the Middle East. Neuroepidemiology. 2017;48(3–4):188–92.CrossRef Saber H, Amiri A, Thrift AG, Stranges S, Bavarsad Shahripour R, Farzadfard MT, et al. Epidemiology of intracranial and extracranial large artery stenosis in a population-based study of stroke in the Middle East. Neuroepidemiology. 2017;48(3–4):188–92.CrossRef
14.
go back to reference Shaikh NA, Bhatty S, Irfan M, Khatri G, Vaswani AS, Jakhrani N. Frequency, characteristics and risk factors of carotid artery stenosis in ischaemic stroke patients at Civil Hospital Karachi. J Pak Med Assoc. 2010;60(1):8–12.PubMed Shaikh NA, Bhatty S, Irfan M, Khatri G, Vaswani AS, Jakhrani N. Frequency, characteristics and risk factors of carotid artery stenosis in ischaemic stroke patients at Civil Hospital Karachi. J Pak Med Assoc. 2010;60(1):8–12.PubMed
15.
go back to reference Liu J, Zhu Y, Wu Y, Liu Y, Teng Z, Hao Y. Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population: a meta-analysis. Neuropsychiatr Dis Treat. 2017;13:527–33.CrossRef Liu J, Zhu Y, Wu Y, Liu Y, Teng Z, Hao Y. Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population: a meta-analysis. Neuropsychiatr Dis Treat. 2017;13:527–33.CrossRef
16.
go back to reference Hassan KM, Verma A, Prakash S, Chandran V, Kumar S, Banerji A. Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study. Ann Indian Acad Neurol. 2013;16(4):516–20.CrossRef Hassan KM, Verma A, Prakash S, Chandran V, Kumar S, Banerji A. Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study. Ann Indian Acad Neurol. 2013;16(4):516–20.CrossRef
17.
go back to reference O’Leary DH, Anderson KM, Wolf PA, Evans JC, Poehlman HW. Cholesterol and carotid atherosclerosis in older persons: the Framingham Study. Ann Epidemiol. 1992;2(1–2):147–53.CrossRef O’Leary DH, Anderson KM, Wolf PA, Evans JC, Poehlman HW. Cholesterol and carotid atherosclerosis in older persons: the Framingham Study. Ann Epidemiol. 1992;2(1–2):147–53.CrossRef
18.
go back to reference Tawfik TZ, Zaki MA, Foad AA, Farrag MA, Auis EB, Hegazy MM. The distribution of atherosclerosis in Egyptian patients with ischemic stroke: extracranial versus intracranial atherosclerotic carotid artery disease; ultrasonographic assessment. Egypt J Neurol Psychiat Neurosurg. 2009;46(2):279–85. Tawfik TZ, Zaki MA, Foad AA, Farrag MA, Auis EB, Hegazy MM. The distribution of atherosclerosis in Egyptian patients with ischemic stroke: extracranial versus intracranial atherosclerotic carotid artery disease; ultrasonographic assessment. Egypt J Neurol Psychiat Neurosurg. 2009;46(2):279–85.
19.
go back to reference Shaheen MA, Albelali AA, AlKanhal RM, AlSaqabi MK, AlTurki RM, AlAskar RS, et al. Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke. Neurosciences (Riyadh). 2019;24(4):264–8.CrossRef Shaheen MA, Albelali AA, AlKanhal RM, AlSaqabi MK, AlTurki RM, AlAskar RS, et al. Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke. Neurosciences (Riyadh). 2019;24(4):264–8.CrossRef
20.
go back to reference Wasay M, Azeemuddin M, Masroor I, Sajjad Z, Ahmed R, Khealani BA, et al. Frequency and outcome of carotid atheromatous disease in patients with stroke in Pakistan. Stroke. 2009;40(3):708–12.CrossRef Wasay M, Azeemuddin M, Masroor I, Sajjad Z, Ahmed R, Khealani BA, et al. Frequency and outcome of carotid atheromatous disease in patients with stroke in Pakistan. Stroke. 2009;40(3):708–12.CrossRef
21.
go back to reference Marine LA, Rubin BG, Reddy R, Sanchez LA, Parodi JC, Sicard GA. Treatment of asymptomatic carotid artery disease: similar early outcomes after carotid stenting for high-risk patients and endarterectomy for standard-risk patients. J Vasc Surg. 2006;43(5):953–8.CrossRef Marine LA, Rubin BG, Reddy R, Sanchez LA, Parodi JC, Sicard GA. Treatment of asymptomatic carotid artery disease: similar early outcomes after carotid stenting for high-risk patients and endarterectomy for standard-risk patients. J Vasc Surg. 2006;43(5):953–8.CrossRef
22.
go back to reference Tan TY, Chang KC, Liou CW, Schminke U. Prevalence of carotid artery stenosis in Taiwanese patients with one ischemic stroke. J Clin Ultrasound. 2005;33(1):1–4.CrossRef Tan TY, Chang KC, Liou CW, Schminke U. Prevalence of carotid artery stenosis in Taiwanese patients with one ischemic stroke. J Clin Ultrasound. 2005;33(1):1–4.CrossRef
23.
go back to reference Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, et al. Early clinical differentiation of cerebral infarction from severe atherosclerotic stenosis and cardioembolism. Stroke. 1992;23(4):486–91.CrossRef Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, et al. Early clinical differentiation of cerebral infarction from severe atherosclerotic stenosis and cardioembolism. Stroke. 1992;23(4):486–91.CrossRef
24.
go back to reference Kazmierski P, Pajak M, Krus-Hadala J, Jeckowski M, Bogusiak K. Screening test for extracranial carotid lesions’ detection in patients of an outpatient vascular clinic. Pol Przegl Chir. 2019;91(5):5–11.CrossRef Kazmierski P, Pajak M, Krus-Hadala J, Jeckowski M, Bogusiak K. Screening test for extracranial carotid lesions’ detection in patients of an outpatient vascular clinic. Pol Przegl Chir. 2019;91(5):5–11.CrossRef
25.
go back to reference Wang MY, Mimran R, Mohit A, Lavine SD, Giannotta S. Carotid stenosis in a multiethnic population. J Stroke Cerebrovasc Dis. 2000;9(2):64–9.CrossRef Wang MY, Mimran R, Mohit A, Lavine SD, Giannotta S. Carotid stenosis in a multiethnic population. J Stroke Cerebrovasc Dis. 2000;9(2):64–9.CrossRef
26.
go back to reference Khedr EM, Elfetoh NA, Al Attar G, Ahmed MA, Ali AM, Hamdy A, et al. Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study. Neuroepidemiology. 2013;40(4):288–94.CrossRef Khedr EM, Elfetoh NA, Al Attar G, Ahmed MA, Ali AM, Hamdy A, et al. Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study. Neuroepidemiology. 2013;40(4):288–94.CrossRef
27.
go back to reference Khedr EM, Fawi G, Abdela M, Mohammed TA, Ahmed MA, El-Fetoh NA, et al. Prevalence of ischemic and hemorrhagic strokes in Qena Governorate, Egypt: community-based study. J Stroke Cerebrovasc Dis. 2014;23(7):1843–8.CrossRef Khedr EM, Fawi G, Abdela M, Mohammed TA, Ahmed MA, El-Fetoh NA, et al. Prevalence of ischemic and hemorrhagic strokes in Qena Governorate, Egypt: community-based study. J Stroke Cerebrovasc Dis. 2014;23(7):1843–8.CrossRef
28.
go back to reference Hasan DM, Emeash AH, Mustafa SB, Abdelazim GE, El-din AA. Hypertension in Egypt: a systematic review. Curr Hypertens Rev. 2014;10(3):134–41.CrossRef Hasan DM, Emeash AH, Mustafa SB, Abdelazim GE, El-din AA. Hypertension in Egypt: a systematic review. Curr Hypertens Rev. 2014;10(3):134–41.CrossRef
29.
go back to reference Mosley JD, Appel LJ, Ashour Z, Coresh J, Whelton PK, Ibrahim MM. Relationship between skin color and blood pressure in Egyptian adults: results from the national hypertension project. Hypertension. 2000;36(2):296–302.CrossRef Mosley JD, Appel LJ, Ashour Z, Coresh J, Whelton PK, Ibrahim MM. Relationship between skin color and blood pressure in Egyptian adults: results from the national hypertension project. Hypertension. 2000;36(2):296–302.CrossRef
30.
go back to reference Shehata GA, Abd-Elwahid L, Fathy M, Nasreldein A. Prevalence of asymptomatic atherosclerosis of extracranial vessels among hypertensive patients in southern Egypt: an extracranial duplex study. Neurosciences (Riyadh). 2020;25(5):386–91.CrossRef Shehata GA, Abd-Elwahid L, Fathy M, Nasreldein A. Prevalence of asymptomatic atherosclerosis of extracranial vessels among hypertensive patients in southern Egypt: an extracranial duplex study. Neurosciences (Riyadh). 2020;25(5):386–91.CrossRef
Metadata
Title
Frequency and risk factors of carotid artery disease among ischemic stroke patients in the south Egypt: hospital-based study
Authors
Eman Khedr
Abeer A. Tony
Mohamed Habeel
Ahmed Nasreldein
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
DOI
https://doi.org/10.1186/s41983-021-00382-5

Other articles of this Issue 1/2021

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery 1/2021 Go to the issue