الفهرس 
VASCULAR ANATOMYOnly 14 pages are availabe for public view
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Abstract
T
he burden of cerebrovascular diseases in developing countries is rising sharply. Stroke and other diseases of the circulatory system are the primary cause of mortality and morbidity in Egypt and worldwide.
Cerebral ischemia is a result of acute arterial occlusion or severe narrowing resulting in impaired blood flow to the brain tissue. Collateral circulation is a dynamic system that helps in preserving cerebral perfusion along with pathophysiologic changes. This system has a huge role in cerebral homeostatic response to ischemia when the primary pathways fail to provide perfusion to critical parts of the brain.
Strokes that are associated with the accumulation of atherosclerotic plaque within the lumen of large or medium-sized arteries (Atherosclerotic strokes) accounts for almost quarter of the causes of ischemic strokes, Risk factors for development of carotid artery atherosclerosis are similar to those for coronary artery includes age, dyslipidemia, hypertension, diabetes, obesity, cigarette smoking and lack of exercise.
In our study we used ultrasonography which is a useful non-invasive, real time, safe tool to assess the extra cranial part of the carotid arteries of the carotid arteries as regards degree of stenosis by measuring the peak systolic velocity using the carotid duplex probe of the Esaote Mylab five systems. It was also used to assess the direction of the ophthalmic artery through the trans orbital window.
This study aimed at analyzing the data of 30 patients with acute ischemic stroke who were admitted at Ain Shams University stroke unit over a 6 months’ period from March 2018 to September 2018, who suffered from significant (>70%) stenosis of the extra cranial part of the carotid artery on the same side of the affected hemisphere, the patients underwent assessment of the ophthalmic artery flow direction as part of the cerebral collateral circulation and their functional outcome was followed up after a period of 3 months using the Modified Rankin Scale(MRS).
In this study, we found that 10 out of our 30 patients had a reversed ophthalmic artery flow direction while the other 20 had a forward flow direction.
We found that 70% of the sample had dyslipidemia and 30% did not, while 43.33% of patients were non diabetics and 56.67% of them were diabetics. As regard smoking 40% of the sample were smokers, 60% of them were non-smokers and as regards Hypertension 53.34% were non hypertensive while 46.66% were hypertensive.
Both studied two groups were compatible as regards the previously mentioned risk factors, p value of difference between both groups as regards smoking, diabetes, hypertension and hyperlipidemia was 0.429, 0.297, 0.301, 0.398 respectively.
As regards their functional outcome there was no significant difference on comparing the difference in MRS between both groups (p= 0.317), although the group with ROAF showed statistically significant improvement as regards their MRS after 3 months with a p value = 0.042.
Finally, the cerebrovascular stroke etiology depends on multiple risk factors, which along with several others play a significant role in determining the outcome in stroke patients, a thorough assessment and investigations are needed for appropriate prediction of the functional outcome in different patients.
In our study we have attempted to highlight the use of ultrasonography in assessing one of the prognostic factors in acute cerebrovascular incidents.