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

Background: After acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), the detection of peripheral arterial disease (PAD) as a marker of generalized atherosclerosis may improve the risk stratification and prevention of future atherothrombotic events. We aimed to determine the prevalence of PAD indicated by an ankle-brachial index (ABI) of ≤0.9 in a large cohort of patients with AIS/TIA. Methods: In this prospective, multicentre, Austrian, cross-sectional study (OECROSS), 759 patients with AIS or TIA were recruited for a systematic assessment of cardiovascular risk profiles and Doppler ultrasound at the ankle and brachial artery to calculate the ABI from systolic blood pressure readings. Results: 739 patients (97.4%) had a complete ABI assessment. The mean age was 69.5 (± 12.1) years, and 55.8% of the patients were men. 81.6% of the patients had AIS and 18.4% had TIA. Only 6.2% of the patients had a history of PAD, but an abnormal ABI of ≤0.9 was found in 44.9%. Patients with an ABI of ≤0.9 were more likely (p < 0.05) to be older and have a history of PAD, hypertension, diabetes and congestive heart failure. An ABI of ≤0.9 was significantly associated (p < 0.0005) with a presence of carotid stenosis of >50% and an Essen Stroke Risk Score of >2, indicating a risk of ≧4% per year of stroke recurrence. Discussion: A high proportion of patients with AIS/TIA have subclinical PAD, a cross-risk stroke physicians should be aware of. Large longitudinal studies are needed to elucidate whether the ABI can improve our estimation of the risk of future atherothrombotic events and help in optimizing secondary prevention.