Prevalence Of Carotid Artery Stenosis And It's Risk Factors In Patients With Ischaemic Stroke As Seen In Kenyatta National Hospital

Abstract

Background: Stroke is the third most common cause of death worldwide and a leading cause of severe disability. Carotid artery stenosis is an important cause of ischaemic stroke and therefore closely related to cardiovascular morbidity and mortality. The carotid Doppler ultrasound is a non invasive method that facilitates the assessment of carotid artery stenosis. It remains unclear whether carotid artery stenosis is as prevalent among Africans with ischaemic stroke as it is in white populations and also whether the risk factors responsible for the development of carotid artery stenosis in whites apply to blacks. Objective: To determine the prevalence of Carotid artery stenosis and its risk factors among ischaemic stroke patients as seen in KNH a tertiary referral health facility in Nairobi Kenya. Design: A cross sectional prospective study . Setting: Medical wards and the neurology clinic of KNH. Subjects: Adult patients above the age of 45 years presenting with ischaemic stroke at KNH. Results: One hundred and twenty six patients fulfilled the inclusion criteria. Significant carotid artery stenosis of 70% or more was present in two (1.6%) of the patients. Thirty one (24.6%) of the patients had normal carotids while mild « 50%) and moderate (51- 69%) stenosis were observed in 88 (69.8%) and 5 (4%) of the patients respectively. Risk factors for ischaemic stroke were present in the following proportions: Dyslipidaemia 76%, .Hypertension 74.6%, Diabetes mellitus 30.2%, smoking 28.6%, obesity 26.2%, excessive Alcohol consumption 17.5%, and impaired fasting glucose in16.9%.All the patients had one or more risk factors. Conclusion: Significant Carotid artery stenosis has a low prevalence of (1.6%) among patients with ischaemic stroke presenting in KNH. With limited resources in our set up, routine screening for extracranial carotid artery disease may not provide extra information to determine stroke aetiology. More resources should be directed towards controlling hypertension, dyslipidaemia, diabetes mellitus and smoking cessation campaigns.