ABSTRACT NUMBER: ESOC2026A1013 IMPLEMENTATION OF A CAROTID ULTRASOUND SCREENING MODEL FOR STROKE PRIMARY PREVENTION IN LOW-RESOURCE SETTINGS: THE ISA-AFRICA EXPERIENCE

Abstract Background and aims In Sub-Saharan Africa, stroke incidence (~316/100,000) represents a major public health challenge. Within the "ISA AFRICA" project, we evaluated a screening model using carotid ultrasonography (CUS) to enhance stroke primary prevention in Kinshasa (DRC), focusing on its feasibility and utility in a low-resource setting. Methods A two-tier screening campaign was implemented. First, a community-based triage identified individuals with high cerebrovascular risk (evaluating age, BMI, hypertension, and diabetes). Second, selected high-risk patients underwent a comprehensive outpatient work-up, including detailed clinical history, 12-lead ECG, and CUS. Results A total of 332 patients were examined in the first screening phase; 103 (31%) were referred for outpatient evaluation. CUS identified carotid atheromasia in 39 patients (38%). Among these, 3 (3%) presented a 50% stenosis, and 2 (2%) had irregular/vulnerable plaques. None of these patients had undergone a prior carotid assessment. 12 patients (9%) were on antiplatelet therapy at baseline, and an antiplatelet was newly prescribed to 13 additional patients depending on CUS findings, clinical history, and overall cardiovascular risk profile. Outpatient comorbidities included hypertension (90%; mean BP 166/97 mmHg), diabetes (14%), and atrial fibrillation (13%). Conclusions Our findings demonstrate that CUS is a highly effective, low-cost, and scalable tool for stroke risk stratification in low-income settings. By identifying subclinical and high-risk plaque features, ultrasound enabled targeted pharmacological interventions in a previously undiagnosed population. In regions like the DRC, where primary prevention is the most sustainable strategy, CUS represents a core technology to bridge the gap in neurovascular care. Conflict of interest Leonardo Bruno: nothing to disclose