“Role Of Caroto-Vertebral Duplex Ultrasonography In Patients With Cerebro-Vascular Accident - Hemodynamic Characterisation & Etiological Stratification”

Introduction: cerebrovascular accident is defined as a sudden, non convulsive focal neurological deficit resulting due to brain ischemia predominantly caused by the thrombo-embolism or with atheromatous carotid plaque as the embolic source1 . Cerebrovascular accident is the leading cause of morbidity in elderly patients with varying degrees of neurological deficit. Since it is a preventable condition and with timely intervention, the severity of the disease can be minimized. Hence, the aim of the present study was real time visualization of vascular lesions to characterize the morphology of vessels for intimal-media complex & for any plaque or stenosis, to quantify the degree and percentage of stenosis in the caroto-vertebral arteries and to correlate the degree of stenosis with severity of clinical disease. Materials and methods: prospective cross-sectional study was conducted on 100 patients presenting with cva with or without persistent neurological deficit referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 60-69 years with 56% being male, 47% presenting with transient ischemic attack, commonest clinical feature being coronary artery disease (29%) followed by haeadache (17%), nausea vomiting (4%), hemiplegia (2%) patients and coma (1%). Hypertension was the most commonest risk factor (59%) followed by diabetes mellitus (18%), hyperlipidemia (14%), atrial fibrillations (5%) and smoking (4%). Majority of plaques were seen in the carotid bulb with variable laterality & echopattern. It was seen that as the degree of stenosis increases the various velocities and their respective ratios (ica psv/ cca psv, ica edv/cca edv, ica psv/cca edv) tend to increase in proportion to the stenosis suggestive of a positive co-relation between them. Conclusion: caroto-vertebral duplex ultrasonography provides a “road map” for carotid endartectomy and/or carotid angioplasty and stenting due to direct visualization of plaque morphology & surface configuration, measurement of the length of stenosed segment, precise determination of grade of stenosis and to get an insight into hemodynamic disorders.