Carotid Atheromatous Disease in Pakistan

Epidemiology of the risk factors for stroke is an important issue in planning for the future prevention strategy for cerebrovascular diseases. Limited data exist on the frequency and outcome of carotid artery disease in Pakistan.
A recent prospective, descriptive study was conducted among 3 large teaching hospitals in Karachi, Pakistan (Stroke. 2009;40: 708) . Patients referred for carotid Doppler ultrasound examination were included if they had experienced a stroke or TIA within the previous month. Demographic and risk factor data were collected at baseline, and the outcome of patients was assessed at least 6 months later.
The results showed that a total of 672 patients underwent bilateral carotid Doppler ultrasound (1344 carotid examinations). The findings revealed 0% to 50% stenosis in 526 (78%), 51% to 69% stenosis in 57 (8%), 70% to 99% stenosis in 82 (12%), and total occlusion in 7 patients (1%). Potentially surgically correctable disease, defined as 70% to 99% carotid artery stenosis, was present in only 79 (12%) patients, of whom 47 (60%) were ipsilateral symptomatic, 15 (20%) asymptomatic, and 17 (20%) had status unknown.
The study concluded that the frequency of carotid artery disease of at least moderate severity is very low in patients with recent stroke or TIA and there is low utilization of high-cost, carotid intervention procedures in Pakistan. The authors mentioned that these data raise questions regarding the applicability and cost-effectiveness of routine carotid ultrasound screening in Pakistan and similar population in Asia.