Ischemic stroke subtypes in Pakistan: the Age Khan University stroke data bank

Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital. We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi. A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 [42.7%]; large artery atherosclerosis 106/393 [26.9%]; cardioembolic 24/393 [6.1%]; undetermined 80/393 [20.3%]; and other determined types 15/393 [3.8%]. The high proportion of lacunar strokes in our population may be due to high burden of inadequately treated hypertension and diabetes. Clear cut cardioembolic stroke was relatively infrequent in our population. Lacunar stroke is the most common subtype of stroke in our patient population. This is most likely secondary to uncontrolled hypertension

Should carotid endarterectomy be performed for symptomatic carotid stenosis in Pakistan?

The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan. Patients who underwent carotid endarterectomy [CEA] at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features, associated medical problems and immediate postoperative complications were recorded and analyzed. Sixty-three carotid endarterectomies were performed on 59 patients. Ages range from 43 to 80 [mean 61 +/- 8] years; 53 were male and 10 were female. Common associated diseases among these patients were hypertension; 38 [64.4%], ischemic heart disease; 26 [44%], diabetes mellitus; 24 [40.7%], dyslipidemia; 19 [32.2%] and renal insufficiency; 13 [22%]. Most common complication was neuropraxia [transient neuropathy]; 5 [7.9%], followed by pneumonia and stroke; each in 3 [4.8%] patients. None of the strokes related to the surgical procedure were disabling. Two of the patients who had stroke, recovered fully within 17 weeks and one recovered partly but was independent in all daily activities of living [ADLs]. One patient died following simultaneous coronary artery bypass graft [CABG] and CEA. The risk of stroke or death for patients undergoing CEA was high with simultaneous CABG [3/11, 27%] and low for patients undergoing CEA alone [1/52, 2%]. Carotid endarterectomy is a safe procedure in patients with symptomatic carotid stenosis at our hospital and should be performed, when indicated