title: Extracranial Carotid Artery Disease: Risk Factors and Outcomes in Patients With Acute Critical Hemispheric Ischemic Stroke.
abstract: OBJECTIVE
  The prevalence of carotid disease in stroke patients has been underestimated because most stroke patients who receive carotid sonography have already survived the acute event. Little is known about the extracranial carotid arteries of patients with acute stroke who need intensive care. This study reviewed color-coded carotid duplex sonographic examinations of the extracranial carotid arteries of patients with acute critical hemispheric ischemic stroke.
  
  
  METHODS
  We retrospectively reviewed 30 consecutive patients who had acute critical hemispheric ischemic stroke and received color-coded carotid duplex sonography in the intensive care unit. The presence of occlusive carotid artery disease was correlated with clinical features, vascular risk factors, and outcomes.
  
  
  RESULTS
  Overall, 57% of the patients (17 of 30) had an occlusive internal carotid artery, and 44% of patients with atrial fibrillation (7 of 16) also had occlusive carotid disease. Eventually, 73% of the patients (21 of 30) had poor outcomes, and 57% (17 of 30) died. The contributing factors to a poor outcome were older age, an initial conscious disturbance, endotracheal intubation, and occlusive carotid disease, with the most significant factor being older age (P = .022; odds ratio, 27.76). The factors contributing to death were endotracheal intubation, occlusive carotid disease, and reversed ophthalmic flow, with the most significant factor being occlusive carotid disease (P = .014; odds ratio, 11.38). Soft homogeneously echogenic thrombi filling the lumen of the internal carotid artery and moving forward and backward with the carotid pulse were found in 3 patients. A small segment of ruptured plaque that was floating forward and backward with pulsation was found in 1 patient.
  
  
  CONCLUSIONS
  Occlusive carotid artery disease is not uncommon among Chinese patients who have had an acute critical hemispheric infarction. Older age is the factor most significantly correlated with a poor outcome, and occlusive carotid disease is the factor most significantly correlated with death.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.).
authors.forename: Siew-Na
authors.initials: SN
authors.lastname: Lim
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.).
authors.forename: Yeu-Jhy
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.). jy0428@totalbb.net.tw sk2022@tzuchi.com.tw.
authors.forename: Shinn-Kuang
authors.initials: SK
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D018616:Ultrasonography, Doppler, Duplex
keywords: acute critical stroke; color-coded carotid duplex sonography; extracranial carotid artery; floating plaque; soft moving thrombus; spontaneous echo contrast; vascular ultrasound