Carotid doppler findings and associated factors among patients admitted with stroke at two selected hospitals in Kampala.

Abstract

ABSTRACT BACKGROUND Stroke is one of the leading causes of preventable death and chronic disability in Uganda. Carotid artery stenosis, thickened CIMT and high-risk atherosclerotic plaques are major risk factors for stroke and for the symptomatic cerebrovascular disease. However, these carotid Doppler characteristics of Ugandans who suffered strokes remains poorly defined. OBJECTIVE In this study we investigated the carotid artery Doppler findings and associated factors in patients admitted with stroke in Mulago and Kiruddu National Referral Hospitals, Kampala, Uganda. METHODS A descriptive, cross-sectional, hospital-based study with a quantitative approach was conducted at Mulago and Kiruddu National Referral Hospitals, Kampala, Uganda between March and July 2022. Study participants above the age of 18 years, admitted with stroke in the region supplied by the internal carotid artery underwent Doppler sonography of the extra cranial carotid arteries using a standard carotid Doppler protocol. Sociodemographic and clinical characteristics were documented for all study participants. Multivariate logistic regression model was constructed to determine strengths of association between the abnormal carotid Doppler parameters and sociodemographic and clinical parameters. Data was analyzed using STATA v17.0 and p<0.05 was considered statistically significant. RESULTS A total of 95 eligible participants, 57 (60%) of whom were male, with a mean age of 61±13 years were recruited. Sixty-four (67%) participants had ischemic stroke. A history of smoking and or alcohol intake was documented in 20% (n=19) and 58.9% (n=56) of the study participants. Hypertension and diabetes were present in 76.4% % (n= 73) and 20% (n=19) of the study participants respectively. The prevalence of significant carotid stenosis in participants with ischemic stroke was 12.5% (8/64) with 7.8% (5/64) of the participants having severe carotid stenosis and 4.7% (3/64) having moderate stenosis. The prevalence of high carotid intima media thickness (CIMT) and atherosclerotic plaques was 31.6%(30/95) and 26.3%(25/95) in the study participants. Factors associated with high CIMT were: Age > 60 years (aOR:5.3, 95% CI: 1.97-14.04 p<001), high low density lipoprotein cholesterol (aOR=4.2, 95%CI: 1.33-13.27, (p=0.014)) and presence of atherosclerotic plaques (aOR= 3.4, 95% CI: 1.29-8.79p=0.013). The atherosclerotic plaques were mostly echogenic (60%) with high-risk echo lucent plaques being present in the reminder of the participants with plaques. CONCLUSION There is a substantial burden of carotid atherosclerotic disease in patients admitted with stroke in Mulago and Kiruddu national referral hospitals. Large scale epidemiological studies are needed to profile the disease in high-risk patients Selected stroke patients with multiple cerebrovascular risk factors maybe candidates for carotid artery screening.