title: Prognostic significance of carotid and vertebral ultrasound in ischemic stroke patients.
abstract: The ultrasound investigation of carotid and vertebral arteries is routinely performed in stroke patients to determine the etiopathogenetic classification and possible need of revascularization. However, the medium and long-term prognostic implications of carotid and vertebral ultrasound in ischemic stroke patients are not yet known.
  
  
  
  This study included 309 ischemic stroke patients (mean age 76.3; 160 men). They all had undergone carotid and vertebral ultrasound (carotid stenoses were measured according to the European Carotid Surgery Trial [ECST] method). After a median interval of 9.4 months, a telephone follow-up was performed to determine their outcome. Dependency or death (modified Rankin scale-mRS >2) and all cause mortality were the study end-points.
  
  
  
  At follow-up, 158 patients had a mRS >2. In multivariate analysis, of 13 variables univariately predictive of dependency or death, only National Institutes of Health Stroke Scale (NIHSS) score (P < 0.0001), age (P < 0.0001) and ipsi- or contralateral carotid stenosis ≥60% (O.R. 3.5, 95% C.I. 1.5-8.6, P = 0.006) remained associated with a mRS >2. Sixty-nine patients had died. In a Cox proportional hazards regression, of 10 variables univariately predictive of mortality, only NIHSS score (P < 0.0001), age (P = 0.003), total anterior circulation syndrome (P = 0.004), vertebral Doppler abnormalities (O.R. 2.2, 95% C.I. 1.3-3.6, P = 0.006), male sex (P = 0.02), and hypercholesterolemia (P = 0.04, inverse relationship) remained associated with mortality.
  
  
  
  In stroke patients, carotid stenoses ≥60%, ipsi- or contralateral to cerebral lesions, were associated with an increased medium and long-term probability of dependency or death, and abnormalities of vertebrobasilar flow were a significant indicator of death risk, independent of stroke severity and age.
authors.affiliation: Stroke Unit - Medical Department of Continuity of Care and Disability S.Orsola-Malpighi Hospital University of Bologna Bologna Italy; Department of Medical and Surgical Sciences S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Muscari
authors.affiliation: Stroke Unit - Medical Department of Continuity of Care and Disability S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonfiglioli
authors.affiliation: Stroke Unit - Medical Department of Continuity of Care and Disability S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Magalotti
authors.affiliation: Stroke Unit - Medical Department of Continuity of Care and Disability S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Puddu
authors.affiliation: Department of Medical and Surgical Sciences S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Zorzi
authors.affiliation: Stroke Unit - Medical Department of Continuity of Care and Disability S.Orsola-Malpighi Hospital University of Bologna Bologna Italy; Department of Medical and Surgical Sciences S.Orsola-Malpighi Hospital University of Bologna Bologna Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality; D014463:Ultrasonography / Q000379:methods / Q000592:standards*; D014711:Vertebral Artery / Q000000981:diagnostic imaging*
keywords: Carotid and vertebral ultrasound; dependency; follow‐up studies; ischemic stroke; modified Rankin scale; mortality; outcome; prognosis