Association of Asymptomatic Peripheral Arterial Disease With Vascular Events in Patients With Stroke or Transient Ischemic Attack

Abstract

Background and Purpose-Patients with stroke and patients with transient ischemic attack (TIA) are at high risk for vascular events and may not exhibit the signs and symptoms of peripheral arterial disease (PAD). We investigated if asymptomatic PAD detected by ankle brachial index Ͻ0.9 is independently associated with recurrent vascular events in patients with stroke or TIA. Methods-In this prospective longitudinal hospital-based cohort study, asymptomatic PAD was detected by ankle brachial index measurement in consecutive patients with stroke and patients with TIA. They were assessed for stroke risk factors, ankle brachial index measurement, and laboratory parameters known to be associated with stroke risk. These patients were followed for composite vascular events, including stroke, TIA, myocardial infarction, and vascular death. Results-In a 1-year period, 102 patients were evaluated, of whom 26% had asymptomatic PAD. All patients were followed for a median period of 2.1 years from the index stroke/TIA (range, 1.0 to 2.7 years) for vascular events. Kaplan-Meier curve showed fewer patients with asymptomatic PAD remained free of composite vascular events (48% compared with 84% in the no-PAD group; log rank, Pϭ0.0001). Asymptomatic PAD was significantly associated with composite vascular events before (hazard ratio, 4.2; 95% CI, 1.9 to 9.3; Pϭ0.0003) and after adjustment for confounders (hazard ratio, from Model 1, 2.8; 95% CI,

High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke

“…In a separate report, the authors provided follow-up data obtained in 729 patients (85.6%) demonstrating a significantly higher rate of recurrent stroke or cardiovascular death and a trend towards a higher rate of recurrent stroke in patients classified as high risk by an ABI of ≤0.9 [16]. These findings have been further corroborated in a recent small study which found asymptomatic PAD, defined by an ABI of <0.9, to be prevalent in 26% of 102 patients with AIS/TIA, and to be associated with recurrent vascular events and stroke over a median follow-up period of 2.1 years [17]. …”

“…In patients with ischaemic cerebrovascular events, data on the prevalence and predictive value of abnormal ABI are limited [10,11,12,13,14,15,16,17]. The prospective Polyvascular Atherothrombosis Observational Survey (PATHOS) found ABI values of ≤0.9 in 253 (33.5%) of 755 patients with acute CVD and in 273 (27.2%) of 1,003 patients with acute coronary syndromes [14].…”

“…There is only limited information available on the prevalence and predictive value of a low ABI in patients with AIS or TIA [10,11,12,13,14,15,16,17]. The aim of this prospective cross-sectional study was to determine the prevalence of PAD indicated by an abnormal ABI of ≤0.9 in patients with AIS/TIA admitted to Austrian stroke units.…”

Pulse pressure and michigan neuropathy screening instrument are independently associated with asymptomatic peripheral arterial disease among type 2 diabetes community residents: A community-based screening program in Taiwan

“…[30,31] One recent prospective cohort study reported that asymptomatic PAD was independently associated with recurrent vascular events and stroke with a significant hazard ratio (HR: 5.2; 95% CI: 1.5 to 17.6; p = 0.008) in patients with stroke or transient ischemic attack. [31] Another hospital-based study examined at the relationship between subclinical PAD and acute stroke or transient ischemic attack (TIA). [32] The results showed that only 6.2% of these patients had a history of PAD but 44.9% actually had an ABI ≤ 0.9.…”

The utility of deformable image registration for small artery visualisation in contrast-enhanced whole body MR angiography

“…PAD has been linked to a 6-fold increase in risk for myocardial infarction [2] and an at least 2-fold rise in the risk of ischaemic stroke [3], and hence the detection of this condition is critical for at-risk patients [4]. PAD involves the build-up of plaque in the arteries (a condition called atherosclerosis), and although patients usually present with a stenosis in one area (and hence diagnostic imaging tends to focus exclusively on that symptomatic area), it is likely that the disease will be manifest asymptomatically elsewhere in the body.…”