Prevalence and Functional Outcomes of Ultrasound-Detected Extracranial Atheromatous Disease in Stroke Patients: A Prospective, Observational Study.

Background: Ischemic stroke remains a leading cause of death and disability worldwide, with extracranial atheromatous or carotid occlusive disease (ECAD) contributing to nearly one-fifth to one-third of cases. Despite its clinical importance, local data on ECAD prevalence and outcomes are limited in Pakistan. This study aimed to determine the prevalence, severity, and functional outcomes of ultrasound-detected ECAD in ischemic stroke patients. Methodology: This prospective observational study was conducted at the Neurology Department, Liaquat National Hospital, from January to July 2025 . Patients with acute to subacute ischemic stroke were included. Data was collected using a standardized questionnaire covering demographics and ultrasound findings of extracranial atheromatous disease. Stroke severity at admission was assessed by NIHSS, and outcomes by the modified Rankin scale (mRS). SPSS version 27 was employed for analysis; the chi-square test was used for associations, and regression analysis provided odds ratios. Results: A total of 187 patients were enrolled in the study. The mean age was 56.90 ± 13.57 years. In terms of extracranial atheromatous disease, 60 patients (32.1%) had stenosis ≤25%, 76 (40.6%) had 26–50% stenosis, 29 (15.5%) had 51–69% stenosis, 16 (8.6%) had 70–99% stenosis, and 6 (3.2%) had total occlusion. Most patients (n=186; 99.5%) were managed conservatively with medical therapy. Functional outcomes by mRS were better in patients with insignificant stenosis at 1 and 6 months (p = 0.15 and <0.001, respectively). Presentation within 36 hours was significantly associated with lower odds of significant stenosis (adjusted OR: 0.071; p < 0.001). Middle cerebral artery involvement showed a significant association (p = 0.014). Conclusion: Significant extracranial atheromatous disease was associated with older age, poorer functional outcomes, and delayed presentation beyond 36 hours.