Carotid stenosis as a risk factor for ischemic stroke

Abstract

Aim – to analyze the effect of carotid stenosis of varying severity in combination with other factors on the risks of primary and recurrent ischemic stroke, using methods of mathematical regression analysis. Material and methods. The study included 606 patients, examined by a neurologist, contrast-enhanced CT scan of the brain, ultrasound of the vessels of the head and neck, other tests and instrumental studies. The degree of carotid stenosis was assessed using the NASCET method (stenosis 0-49%, 50-69%, 70% or more). For the purpose of mathematical analysis, patients were divided into 3 comparison groups: those without a history of stroke, patients with a single stroke, and a group of patients with two or more ischemic strokes. In patients with a history of stroke, the size of the ischemic lesion was assessed according to CT data, the severity of neurological deficit according to the NIHSS scale and the recovery degree, and the functional outcome of ischemic stroke (Rankin scale, Rivermead index). The study used logistic regression analysis to assess the relationship between the dependent variable (presence of primary or recurrent stroke) and a set of predictors, which were a number of clinical and instrumental indicators. Results. The presence of carotid stenosis of 50-69%, when combined with pathology of the cardiovascular system, acts as a factor that significantly increases the risk of developing primary ischemic stroke. Stenosis exceeding 70% has a high level of significance in the risk of recurrent ischemic stroke, this fact should be taken into account for secondary prevention of stroke. Conclusion. A preliminary assessment and analysis of carotid stenosis degree and other comorbid factors co-influencing the risks of primary and recurrent ischemic stroke has an undoubted potential. This approach can reduce the risk of recurrent vascular accidents and help organizing a personalized approach to surgical treatment of patients.

Keywords

• carotid stenosis
• ischemic stroke
• risk factors
• regression analysis