Evaluation of extracranial carotid atheromatous plaque and stenosis in patients with acute ischemic stroke

Background and Objective: Acute ischemic stroke remains a leading cause of death and disability worldwide. The development of atherosclerotic changes in the extracranial carotid arteries, such as increased intima-media thickness (IMT), atheromatous plaque formation, and stenosis, is a significant contributor to cerebral ischemia. These vascular alterations are crucial in the pathophysiology of ischemic stroke, as they can lead to embolic events and impaired blood flow to the brain. Colour duplex ultrasonography is a non-invasive, widely accessible, and reliable diagnostic tool for detecting and assessing these carotid artery changes. The primary aim of this study was to evaluate the causes and characteristics of carotid stenosis in patients diagnosed with acute ischemic stroke. Materials and Methods: This cross-sectional observational study was conducted at the department of Radiology and Imaging at Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from July 2021 to June 2023. A total of 52 patients who presented with acute ischemic stroke, confirmed through clinical and radiological diagnostic tests, were selected using purposive sampling. Colour duplex ultrasound was employed to assess the extracranial carotid arteries of all patients. The study collected data on sociodemographic factors, clinical presentation, vascular risk factors, carotid IMT, plaque characteristics, plaque location, and the severity of carotid stenosis.Statistical analysis was performed using SPSS version 26.0. Results: The most common presentation was unilateral weakness (88.5%), with other features including dysphonia, unsteadiness, and dysphagia. Hypertension was the most prevalent vascular risk factor (65.4%).The middle cerebral artery (MCA) territory was the most frequently affected vascular region. Carotid IMT was found to be increased in 67.0% of patients, while atheromatous plaques and carotid stenosis were observed in 53.8% and 76.9% of patients, respectively. Most stenoses were mild, with less than 50% stenosis reported in the majority of cases. Carotid plaques were predominantly located at the carotid bifurcation, and these plaques were strongly associated with stenosis (p<0.001). Furthermore, carotid stenosis was significantly associated with older age, hypertension, dyslipidemia, and increased carotid IMT. Conclusion: The study demonstrates a high prevalence of carotid atherosclerosis in stroke patients, with an observed association between stenosis and risk factors like age, hypertension, and dyslipidemia. However, the cross-sectional design precludes establishing causality. January 2026; Vol. 20(1):008. DOI: https://doi.org/10.55010/imcjms.20.008 *Correspondence: Shakhawat Hossain, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. Email: dr.shakhawathoss@gmail.com.