الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Stroke is clinically defined as the syndrome of rabidly developing symptoms and signs of focal or global loss of cerebral function with no apparent cause other than of vascular origin. It is the third cause of death after coronary artery disease and all types of cancers.
Two-thirds of strokes are ischemic in origin and 50% of these are associated with severe internal carotid artery disease, The underlying, predominant cause of carotid artery disease is atherothrombosis.
This study is descriptive ,Cross sectional study that was conducted in the department of Radiology, Minia university hospital from 10-2021 through 10-2022
Thirty patients were enrolled in this study who were clinically and radiologically diagnosed as CVI (cerebrovascular insults ) whether acute ischemia or TIA at neurology department then referred to our radiological department .
Those thirty patients were divided into two groups , Acute ischemic patients group ( twenty) and transient ischemic patients group( ten) ..
All patients were assessed by carotid duplex and carotid MRI for the following :-
By carotid Duplex :- Site of the atheromatous plaque , its echogenicity,Regularity of surface, Presence of calcifications, thrombus on top, luminal stenosis .
By carotid MRI :- Site of the atheromatous plaque , its lipid core and fibrous cap , surface ulceration , Presence of calcifications, thrombus on top, luminal stenosis . and intra plaque hemorrhage.
At acute ischemic stroke paients group ( twenty patients ):- By carotid Duplex , it was found that most of the atheromatous plaques were hypoechoic 12(60%), and had irregular surface 15(75%) with statistically significant P value (0.03, 0.04) respectively. Most atheromatous plaques 9(45%) caused about 70-90 % luminal stenosis , Also most plaques had calcification 13(65%) as well as thrombus on top 12(60%) with statistically non significant P value (0.3, 0.2, 0.2) respectively.
By carotid MRI , most of the atheromatous plaques had thin fibrous cap with lipid rich core 18(90%), ulcerated surface 18(90%), calcification 15(75%) , thrombus on top 16(80%) as well as hemorrhage within the plaque 15(75%) with statistically significant P value (0.0001, 0.0001, 0.04, 0.001,0.04) respectively.Most atheromatous plaques 10(50%) caused about 70-90 % luminal stenosis with statistically non significant P value 0.4
At TIA paients group ( ten patients ):- By carotid Duplex, majority of patients 9(90%) had not thrombus on top of their atheromatous plaques with statistically significant P value 0.0003. Most atheromatous plaques affected left carotid arteries(CCA,ICA) more than right 7(70%), with hypoechoic texture 6(60%), irregular surface 7(70%), Also some plaques had calcification 4(40%) with statistically non significant P value (0.7, 0.1, 0.07, 0.3) respectively.
By carotid MRI, most of the atheromatous plaques had thin fibrous cap with lipid rich core 9(90%), ulcerated surface 9(90%), as well as hemorrhage within the plaque 8(80%) with statistically significant P value (0.0003, 0.0003, 0.0007) respectively. Majority of patients had not thrombus on top of plaques with statistically significant P value 0.0003. Most atheromatous plaques affected left carotid arteries 7(70%) than right , they also had calcification5(50%) with statistically non significant P value (0.07, 0.9) respectively.
At the end , it was evidenet that carotid atheromatous plaques at both groups had specific criteria made them of high risk for ischemic anterior cerebrovascular insults to occur other than degree of stenosis, that is called vulnerable criteriaof the atheromatous plaques.
All acute ischemic stroke patients 20(100%) had one or more of the vulnerability criteria for carotid atheromatous plaques. The most common criteria noted were rich lipid necrotic core of plaque 18(90%), surface ulceration 18(90%) as well as thrombosis on top of plaques 16(80%) , In addition to calcification of plaque 15(75%) and hemorrhage within plaque 15(75%).
All TIA patients 10(100%) had one or more of the vulnerability criteria for carotid atheromatous plaques. The most common criteria noted were rich lipid necrotic core of plaque 9(90%), surface ulceration 9(90%) and hemorrhage within plaque 8(80%). To lesser extent calcification of plaque 5(50%).
Carotid duplex was still the basic examination modality in carotid artery assessment as it is simple, cheap, easy to applied , non invasive, rapid.
Carotid Duplex was used as 1st step in scanning acute stroke ot TIA patients as it is available , rapid , cheap and easy to apply , there was no significant difference in detcetion of degree of luminal stenosis , surface irregularity of plaque or thrombus on top of plaques detcetd by carotid duplex vs carotid MRI with the following P value respectively (0.9-0.9-0.3).
Also it has exclusive role in detection of semidetached thrombus moving with the blood flow stream with cardiac cycle within the lumen.
MRI has exclusive role in detection of lipid core, fibrous cap status of atheromatous plaques as well as intra plaque hemmorrage .