Assessing the Prevalence of Intra-and-Extra Cranial Arteries Stenosis in Diabetic Patients with Hypertension by Transcranial Doppler Sonography

Stroke is one of the most common causes of mortality and morbidity worldwide. In addition to the effects of some risk factors like old age, hypertension, hyperlipidemia and smoking, the prevalence of this disorder is twice as high in diabetic as compared to nondiabetic patients. The purpose of this survey to detect asymptomatic intracranial stenosis and to determine its risk factors in hypertensive diabetic patients aged over 50 years using Transcranial Doppler Sonography(TCD). Diabetic patients aged over 50 years with hypertension and no previous history of cerebrovascular problems were invited, and initially a questionnaire on demographic information, smoking, history of hyperlipidemia, duration of diabetes and hypertension and physical exams was completed. Then evaluation of peak systolic flow velocity (PSV) in middle cerebral (MCA) internal carotid (ICA) and vertebral arteries (VA) was done by TCD, PSV ≥ 120 cm/sec for MCA and ICA and PSV ≥ 100 cm/sec for VA over 50% stenosis of arterial wall diameter was classified (defined) as significant stenosis,. Student t test, analyze of variance and non parametric tests were used for data analysis. Overall 108 patients with mean age 62.51±7.90 years were studied, of which 22 (20.3%) patients (11male, 11 female) had stenosis and 34 (31.4%) stenotic arteries were also detected 7 out of 22 patients (32%) had multiple stenosis. Mean durations of hypertension in these two groups were 5.36±1/7and 3.07±0.39 years respectively (P = NS), and mean durations of diabetes were 14.09±1/8 and 8.15±0/72 years respectively (P< 0.01). Of 22 (41%), 9 had hyperlipidemia, with 6 of them having multiple involvement, whereas only 1 out of 13 patients without hyperlipidemia had multiple stenosis. (P<0/003). More than 20% of our patients had significant but asymptomatic cerebral artery stenosis 30% of patients had multiple artery Involvement. There was no relation between occurence of stenosis and age, sex or duration of hypertension, but there was a significant relation between prevalence and multiplicity of stenoses and the duration of diabetes and also the presence of hyperlipidemia. Periodic evaluation of cranial vessels hence, in aged diabetic patients with risk factors of atherosclerosis using TCD is recommended.