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A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome

BACKGROUND: In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, the...

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Autores principales: Kamtchum-Tatuene, Joseph, Mwandumba, Henry C., Mwangalika Kachingwe, Gloria, Bonnett, Laura J., Kayange, Noel, Solomon, Tom, Benjamin, Laura A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006928/
https://www.ncbi.nlm.nih.gov/pubmed/32032392
http://dx.doi.org/10.1371/journal.pone.0229033
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author Kamtchum-Tatuene, Joseph
Mwandumba, Henry C.
Mwangalika Kachingwe, Gloria
Bonnett, Laura J.
Kayange, Noel
Solomon, Tom
Benjamin, Laura A.
author_facet Kamtchum-Tatuene, Joseph
Mwandumba, Henry C.
Mwangalika Kachingwe, Gloria
Bonnett, Laura J.
Kayange, Noel
Solomon, Tom
Benjamin, Laura A.
author_sort Kamtchum-Tatuene, Joseph
collection PubMed
description BACKGROUND: In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, therefore, represent a reasonable alternative to fill this knowledge gap. We explored the feasibility of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome to inform the design of future large stroke studies comparing its diagnostic performance to that of gold standard vascular imaging techniques in sub-Saharan Africa. METHODS: We enrolled consecutive patients diagnosed with acute stroke-like syndrome based on the World Health Organization definition. Clinical and demographic data were recorded, and a comprehensive neurovascular ultrasound was performed. Fisher’s exact and Kruskal-Wallis tests were used to study the relationship between atherosclerosis and potential risk factors. RESULTS: Sixty-six patients were enrolled (mean age: 58.7 years). The frequency of extracranial atherosclerosis was 39.4% (n = 26, 95% CI: 28.6–52.2). There were 12 patients with abnormal carotid intima media thickness (18.2%, 95% CI: 9.8–29.6) and 14 patients with a carotid plaque (21.2%, 95% CI: 12.1–33.0). The frequency of intracranial atherosclerosis was 19.2% (95%CI: 6.6–39.4) in 26 patients with successful transcranial insonation. Hypertension (80.8 versus 52.5%, p = 0.03) and hypercholesterolemia (11.5 versus 0.0%, p = 0.05) were more prevalent in patients with extracranial atherosclerosis. CONCLUSIONS: This study demonstrates the feasibility of neurovascular ultrasound to assess cervical arteries in adults with stroke-like syndrome in sub-Saharan Africa. There is a high rate of transcranial insonation failure in this setting, highlighting the need for echocontrast agents.
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spelling pubmed-70069282020-02-19 A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome Kamtchum-Tatuene, Joseph Mwandumba, Henry C. Mwangalika Kachingwe, Gloria Bonnett, Laura J. Kayange, Noel Solomon, Tom Benjamin, Laura A. PLoS One Research Article BACKGROUND: In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, therefore, represent a reasonable alternative to fill this knowledge gap. We explored the feasibility of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome to inform the design of future large stroke studies comparing its diagnostic performance to that of gold standard vascular imaging techniques in sub-Saharan Africa. METHODS: We enrolled consecutive patients diagnosed with acute stroke-like syndrome based on the World Health Organization definition. Clinical and demographic data were recorded, and a comprehensive neurovascular ultrasound was performed. Fisher’s exact and Kruskal-Wallis tests were used to study the relationship between atherosclerosis and potential risk factors. RESULTS: Sixty-six patients were enrolled (mean age: 58.7 years). The frequency of extracranial atherosclerosis was 39.4% (n = 26, 95% CI: 28.6–52.2). There were 12 patients with abnormal carotid intima media thickness (18.2%, 95% CI: 9.8–29.6) and 14 patients with a carotid plaque (21.2%, 95% CI: 12.1–33.0). The frequency of intracranial atherosclerosis was 19.2% (95%CI: 6.6–39.4) in 26 patients with successful transcranial insonation. Hypertension (80.8 versus 52.5%, p = 0.03) and hypercholesterolemia (11.5 versus 0.0%, p = 0.05) were more prevalent in patients with extracranial atherosclerosis. CONCLUSIONS: This study demonstrates the feasibility of neurovascular ultrasound to assess cervical arteries in adults with stroke-like syndrome in sub-Saharan Africa. There is a high rate of transcranial insonation failure in this setting, highlighting the need for echocontrast agents. Public Library of Science 2020-02-07 /pmc/articles/PMC7006928/ /pubmed/32032392 http://dx.doi.org/10.1371/journal.pone.0229033 Text en © 2020 Kamtchum-Tatuene et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kamtchum-Tatuene, Joseph
Mwandumba, Henry C.
Mwangalika Kachingwe, Gloria
Bonnett, Laura J.
Kayange, Noel
Solomon, Tom
Benjamin, Laura A.
A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title_full A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title_fullStr A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title_full_unstemmed A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title_short A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome
title_sort cross-sectional feasibility study of neurovascular ultrasound in malawian adults with acute stroke-like syndrome
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006928/
https://www.ncbi.nlm.nih.gov/pubmed/32032392
http://dx.doi.org/10.1371/journal.pone.0229033
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