Carotid Arterial Plaque and Clinical Factors in Stroke Patients with Dementia

Abstract

Carotid arterial stenosis becomes more common and important risk factor for stroke patients with dementia in Asian area. We reviewed stroke database to investigate clinical factors related to carotid arterial stenosis, including intracranial arterial stenosis and peripheral arterial disease which reflects advanced atherosclerosis in patients with dementia. Acute stroke patients with dementia whose stroke onset were within 1 week when admitted at the National Health Insurance Corporation Ilsan Hospital from January 2008 to December 2010 with available carotid ultrasound study, transcranial Doppler (TCD) examination and ankle-brachial indexes (ABI) formed the analysis cohorts. Retrospective review was performed. A total of 304 patients were included during that period. By duplex ultrasound, common/internal carotid arteries are examined and the greatest diameter of plaques are recorded. 3 groups of carotid arterial plaques are defined: diameter is less than 2mm (112 patients, 37%), 2-4mm (174 patients, 57%) and greater than 4mm (18 patients, 6%). As the size of carotid arterial plaques increased, ABI is decreased (P = 0.000) and the number of intracranial arterial stenosis is increased (P = 0.008). Among the risk factors, Age, diabetes, male patients are increased (P = 0.000, P = 0.047, P = 0.004) and smoking history showed tendency of increase (P = 0.057) as diameter of carotid arterial plaque increase. However hypertension, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride and past stroke history are not correlated with carotid arterial stenosis. Among the acute stroke patients with dementia, more than a half of them have carotid arterial plaque which diameters are greater than 2mm and these patients tend to have higher burden of advanced atherosclerosis as evidenced by a higher prevalence of diabetes, intracranial arterial stenosis and peripheral arterial occlusive disease.