Mortality and Recurrence in Acute Ischemic Stroke of All Etiologies According to Ultrasonographic Assessment of Carotid and Aortic Arch Plaques: A Prospective Study.

Carotid duplex ultrasound helps to determine the degree of stenosis or occlusion and characterizes plaque composition and vulnerability, which is crucial for stroke risk stratification. Recurrent ischemic stroke poses a significant risk to individuals, with about one-third of stroke survivors experiencing a repeat event within five years. Older age, previous stroke or transient ischemic attack, atrial fibrillation, and large-artery atherosclerosis further increase the risk of recurrent strokes and influence prognosis. Moreover, stroke can result in worse outcomes, including higher morbidity, mortality, and cardiovascular complications in the three years after. This study aims to evaluate the link between ultrasound characteristics of aortic and carotid plaques and the risk of mortality and recurrent stroke among patients with acute ischemic stroke. One hundred-eight patients with first-episode acute ischemic stroke, a mean age of 71.3(13.4) years, underwent carotid Duplex and transthoracic aortic arch ultrasounds. They were followed up every 6 months for three years. The results revealed that while carotid plaques and stenosis were not significantly associated with recurrent stroke, the absence of plaques was related to higher survival rates (p = 0.008). Conversely, the simultaneous presence of plaques in both common and internal carotids was associated with increased mortality (p = 0.004). Finally, echo-lucent intimal lesions, according to the Gray-Weale classification considered high-risk plaque, showed good sensitivity (89.6%) but poor specificity in predicting outcomes at 3 years (AUC = 0.63, p = 0.0164). These findings suggest that routine non-invasive ultrasound evaluation of both carotid and aortic arch can be beneficial in stratifying patients for secondary prevention and improving stroke care.