الفهرس 
Acknowledgment
Ischemic StrokeOnly 14 pages are availabe for public view
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Abstract
During a 12 months period, from September 2016 to August 2017, we conducted a prospective study comprising 645 neurologically asymptomatic patients with PAD (Fontaine IIb-IV) who underwent carotid duplex screening pre-revascularization procedure (percutaneous transluminal angioplasty).
There were 458 (71%) males and 187 (29%) females with mean age of the patients were 63.77 ± 8.26 years old, ranging from 50 to 92 yr.
All the patients in this study had one or more risk factors such as diabetes mellitus (DM) 23.6%, arterial hypertension (HTN) 28.4%, ischemic heart disease (IHD) 34%, smoking 29.5% and hyper-cholesterolemia 5%.
Critical limb ischemia was the indication for revascularization in the patients (74.1%), whereas disabling claudication was indicated in the remaining patients (25.9%). The level of occlusion was aortoiliac in (23.7%), infrainguinal in (41.4%) and combined aortoiliac and infrainguinal arterial in (34.9%).
The mean of intimal media thickness in the total patients on the right CCA was 0.06cm and on the left CCA was0.07cm. The mean of peak systolic velocity (PSV) in the total patients on the right CCA was 71.04 cm/sec and on the left CCA was75.22 cm/sec.The mean of peak systolic velocity (PSV) in the total patients on the right ICA was 63.07 cm/sec and on the left ICA was73.60 cm/sec. The mean of ICA/CCA peak systolic velocity ratioin the total patients on the right ICA was1.10 and on the left ICA was 1.40.
The mean of end diastolic velocity (EDV) in the total patients on the right CCA was 15.72 cm/sec and on the left CCA was19.26 cm/sec. The mean of end diastolic velocity (EDV) in the total patients on the right ICA was 17.40 cm/sec and on the left ICA was 21.20 cm/sec.
In this study, 302 patients (46.8%) had patent carotid arteries without any evidence of atherosclerotic plaque. ACAS <50% was shown in 248 patients (38.4%), ACAS 50-69% was shown in 73 patients (11.3%), ACAS≥ 70%was shown in 18 patients (2.8%) and total ICA occlusion was shown in 4 patients (0.6%).
This study revealed also critical carotid stenosis was more common in patientsaged more than 65 years old(68.2%, P=0.013) and in males (90.9%, P=0.022).
We reported that critical carotid stenosiswas found more commonly in hypertension (68.2%, P=0.000) and in ischemic heart disease (54.5%, P=0.016).
Our results showedcritical carotid stenosis and ICA occlusion were more common ininfrainguinal occlusive disease (68.2%, P=0.015) and more common in chronic lower limb ischemia fontaine grade IV with gangrene (50%, P=0.044).
Conclusion
Preoperative Carotid duplex is a useful screening tool to detect ACAS and to assess perioperative risk of cerebrovascular complications in PAD patients who undergo revascularization.
Carotid duplex is a non-invasive and valuable tool and can avoid missing a patient with a significant lesion which may attempt successful interventions (carotid artery stenting or carotid endartrectomy) to lower the risk of stroke.
Patients who are in age of >65 years old or male gender are highly susceptible to have significant carotid artery stenosis.
The prevalence of asymptomatic carotid artery stenosis is high in patients with severe peripheral artery disease especially critical limb ischemia.
Concomitant risk factors such as hypertension and ischemic heart disease are highly associated with significant carotid artery stenosis.
There is great need and demand for such early screening programs because it could potentially benefit in disease prevention.
There is a higher need for General Practitioners to actively inform their patients in the benefits of this screening method and the possible advantages of non-invasive techniques, higher accuracy and efficiency of these tests.
The promotion of using carotid duplex is fundamental to decreasing the disease burden from hospitals and tertiary care units and moving towards more community based approach of disease prevention.