Coexistent extra- and intracranial stenosis, cervical atherosclerosis, and abnormal ankle brachial index in acute ischemic stroke

J Stroke Cerebrovasc Dis. 2012 Nov;21(8):782-9. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.006. Epub 2011 May 18.


Background: There are limited data regarding abnormal ankle brachial index (ABI) with coexistent extracranial carotid stenosis (ECS), intracranial stenosis (ICS), and nonstenotic cervical atherosclerosis (CAS) in stroke, especially in Asia.

Methods: We studied the prevalence of ECS, ICS, CAS, and combined ECS and ICS in 756 Thai patients with acute ischemic stroke and correlated sites of atherosclerosis with stroke risk factors and abnormal ABI.

Results: The prevalence of ECS was 8.8%, ICS 52.6%, CAS 36.0%, abnormal ABI 18.8%, combined ECS and ICS 4.6%, combined ECS and abnormal ABI 2.8%, combined ICS and abnormal ABI 10.6%, and combined ECS, ICS, and abnormal ABI 1.6%. The prevalence of ECS, CAS, and combined ECS and ICS was higher in abnormal ABI compared to normal ABI (14.8% v 7.5% [P = .006]; 46.5% v 33.5% [P = .004], and 8.4% v 3.7% [P = .016], respectively). ECS was significantly correlated with history of coronary artery disease (CAD) and abnormal ABI; ICS with male gender, no alcohol use, and no atrial fibrillation; CAS with age ≥ 60 years, history of CAD and abnormal ABI; and combined ECS and ICS with history of CAD.

Conclusions: The frequency of atherosclerosis, especially ICS, was high. Cervicocerebral atherosclerosis was higher in abnormal ABI. This suggests that ischemic stroke patients should be screened for ECS, CAS, ICS, and abnormal ABI, especially in specific subsets (age ≥ 60 years, male gender, and history of CAD). The improved identification of vascular lesions could allow for a more optimal choice of antithrombotics, neurointervention, and more aggressive control of risk factors, potentially improving prevention of disease progression and a decrease in recurrent vascular events.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index*
  • Asian Continental Ancestry Group
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / ethnology
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / epidemiology*
  • Carotid Stenosis / ethnology
  • Chi-Square Distribution
  • Coronary Artery Disease / epidemiology
  • Female
  • Humans
  • Intracranial Arteriosclerosis / diagnosis
  • Intracranial Arteriosclerosis / epidemiology*
  • Intracranial Arteriosclerosis / ethnology
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / epidemiology*
  • Peripheral Arterial Disease / ethnology
  • Predictive Value of Tests
  • Prevalence
  • Registries
  • Risk Factors
  • Sex Factors
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Stroke / ethnology
  • Thailand / epidemiology
  • Ultrasonography, Doppler, Duplex
  • Ultrasonography, Doppler, Transcranial