The impact of vascular risk factors multiplicity on severity of carotid atherosclerosis—A retrospective analysis of 1969 Egyptian subjects

Background and Purpose: Carotid atherosclerosis has been recognized as a major cause of stroke. The cur-rent study aimed to describe the effect of multiplicity rather than the type of vascular risk factors on severity of carotid atherosclerosis among a large sample of Egyptian population. Methods: We analyzed the data of 1969 Egyptian subjects, who proved to have extra cranial carotid atherosclerotic disease by duplex scanning at the vascular laboratories of Cairo Uni-versity Hospitals. Demographic, clinical data and causes of referral were recorded and correlated with ultrasound findings. Atherosclerotic indices, namely IMT, plaque number and percentage of stenosis were used for evaluation of severity of carotid atherosclerosis. Furthermore, subjects were classified according to multiplicity of major atherosclerotic risk factors and multivariate regression analysis was performed to detect independent predictors of significant carotid disease. Results: Out of 1969 subjects with proved signs of extracranial carotid atherosclerosis by duplex ultrasonographic scan, 225 (11.4%) showed hemody-namic significant stenosis (≥50%). Multiplicity of risk factors beyond the age of 50 years was the strongest predictor of significant stenosis. Conclusion: Age more than 50 years and multiplicity rather than the type of risk factors were the strongest predictors of significant carotid atherosclerotic disease (CAD).

Multiple Major Thrombo-Embolic Events, including Stroke, in a Patient with Combined Congenital Anti-Thrombin III Deficiency and MTHFR Homozygous Mutation

We report a case of a young male patient suffering from congenital Anti-Thrombin III (AT III) deficiency, presented with four major thrombotic events. These events were acute coronary syndrome (Non-ST elevation myocardial infarction), cerebral infarction, peripheral acute upper limb (UL) ischemia and bilateral extensive deep venous thrombosis. The latter two developed despite that the patient was receiving full anticoagulation therapy. His International normalized ratio (INR) was 2.5. Eventually, the patient developed pulmonary embolism and died. He had a prominent family history of thrombotic events. Screening for AT III deficiency in young patients with thrombotic event (thrombophilia) is essential especially those having family history of the latter. This is justified as thrombotic events may occur in up to 80% of these patients. Our patient with 4 major thrombotic events ending in fatality in less than 1 month deserves the nomenclature.

Low Ankle Brachial Index in Acute Ischemic Stroke: Does ApoE Gene Polymorphism Have a Role?

Background: The existence of asymptomatic peripheral arterial disease among patients with acute ischemic stroke has been studied and proved. Low ankle brachial index (ABI) is considered as a marker of atherosclerosis, and its relation to stroke severity was documented in some studies. The effect of different alleles of ApoE gene on acute ischemic stroke presentation in patients with low ABI is not known. Objective: To study the effect of ApoE gene polymorphism on stroke severity, outcome and recurrence in patients with asymptomatic peripheral arterial disease identified by low ABI. Methods: Patients with acute ischemic stroke were screened for the presence of asymp-tomatic peripheral arterial disease by estimating the ABI using a pocket Doppler ultrasound device. Assay of ApoE gene was done using the real-time PCR technique. Results: Low ABI was present in 31% of patients with acute ischemic stroke. There was no significant difference among patients with different ApoE alleles regarding the severity of their symptoms. Also, there was no significant difference among patients with normal ABI and those with abnormal ABI regarding the ApoE gene polymorphism. Conclusion: The current study showed that there was no significant relation between ApoE gene polymorphism and low ABI in ischemic stroke patients who had asymptomatic peripheral arterial disease.