The Association between Ankle–Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients

Q: What are the key findings of this study?

Abnormal ankle-brachial index independently predicted moderate to severe extracranial and severe intracranial artery stenosis in acute ischemic stroke patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=820). Intervention: Abnormal ankle-brachial index (ABI 1.4) and brachial-ankle pulse wave velocity (baPWV) vs. Normal ABI (0.9-1.4) and mild vessel stenosis reference group (<30% stenosis). Primary outcome: Severe extracranial artery stenosis (≥70% diameter stenosis) (OR 5.59, 95% CI 2.21-14.13, p=<0.001).

Q: What does this research mean for the field?

Abnormal ankle-brachial index independently predicts moderate to severe extracranial and severe intracranial artery stenosis, but neither ankle-brachial index nor pulse wave velocity independently predicts cerebral small vessel disease severity in acute ischemic stroke patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether the ankle–brachial index (ABI) and brachial–ankle pulse wave velocity (baPWV) correlate with and predict the severity of cerebral small vessel disease (SVD) and large artery atherosclerosis (LAA) in ischemic stroke patients.

Yu-Ming Chang; Tsung-Lin Lee; Hui‐Chen Su; Chung-Yao Chien; Tien-Yu Lin; Sheng‐Hsiang Lin; Chih‐Hung Chen; Pi‐Shan Sung

doi:10.3390/diagnostics13081455

April 18, 2023DiagnosticsOpen Access

The Association between Ankle–Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients

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Key result

Abnormal ankle-brachial index is linked to ~5.6-fold higher odds of severe extracranial artery stenosis.

OR 5.59
95% CI 2.21-14.13
P<0.001
n=820

Figures

Why the study?

It was unknown whether the ankle–brachial index and pulse wave velocity could reflect the severity of cerebral small vessel disease and large artery atherosclerosis in stroke patients.

Does ankle-brachial index or pulse wave velocity predict the severity of cerebral small vessel disease and large artery atherosclerosis in patients with ischemic stroke?

Key Points

To determine whether the ankle–brachial index (ABI) and brachial–ankle pulse wave velocity (baPWV) correlate with and predict the severity of cerebral small vessel disease (SVD) and large artery atherosclerosis (LAA) in ischemic stroke patients.
Prospectively enrolled 956 consecutive patients with ischemic stroke between July 2016 and December 2017, with 820 included in the final analysis.
Assessed LAA stenosis grades and SVD severity using brain magnetic resonance imaging, magnetic resonance angiography, and carotid duplex ultrasonography.
Evaluated correlations and performed multinomial logistic regression to identify independent predictors of stenosis and SVD severity.
Extracranial and intracranial vessel stenosis grades inversely correlated with ABI (p < 0.001 for both) and positively correlated with baPWV (p < 0.001 and p = 0.004, respectively).
Neither ABI nor baPWV was independently associated with the severity of moderate to severe cerebral SVD after adjusting for confounding factors such as age.

Study Design

Type

Cohort (n=820)

Multicenter

No

Structured PICO

Does ankle-brachial index or pulse wave velocity predict the severity of cerebral small vessel disease and large artery atherosclerosis in patients with ischemic stroke?

P

Population

820 patients in Taiwan (median age 68 years, 38.9% female) presenting within 10 days of acute ischemic stroke who underwent brain MRI/MRA and carotid duplex ultrasonography.

E

Exposure

Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) measurement

O

Outcome

Severity of small vessel disease (SVD) and large artery atherosclerosis (LAA) stenosis grades evaluated via magnetic resonance imaging and carotid duplex ultrasonographysurrogate

Main Result

Odds Ratio: 5.59 (95% CI 2.21–14.13)

p-value: p=<0.001

Abnormal ABI is a useful screening tool for identifying cerebral large vessel disease, but neither ABI nor baPWV predicts cerebral small vessel disease severity in ischemic stroke patients.

Limitations

Excluded 136 patients lacking sufficient vascular or brain imaging, who may have had worse clinical conditions and higher vascular burden
All patients were evaluated during the acute stage of stroke, limiting generalizability to the chronic stroke stage
ABI and baPWV were measured only once after admission
Exact time period from stroke onset to ABI/baPWV measurement was not included in the multivariate analysis
ABI may underestimate peripheral atherosclerosis due to falsely high values from medial artery calcification

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Abnormal ABI may support screening for large-vessel stenosis in ischemic stroke; leaves open its role in small-vessel disease and routine adoption.

Abstract

(1) Background: The study investigated whether the ankle–brachial index (ABI) and pulse wave velocity (baPWV) could reflect the severity of small vessel disease (SVD) and large artery atherosclerosis (LAA). (2) Methods: A total of 956 consecutive patients diagnosed with ischemic stroke were prospectively enrolled from July 2016 to December 2017. SVD severity and LAA stenosis grades were evaluated via magnetic resonance imaging and carotid duplex ultrasonography. Correlation coefficients were calculated between the ABI/baPWV and measurement values. Multinomial logistic regression analysis was performed to determine predictive potential. (3) Results: Among the 820 patients included in the final analysis, the stenosis grade of extracranial and intracranial vessels was inversely correlated with the ABI (p < 0.001, respectively) and positively correlated with the baPWV (p < 0.001 and p = 0.004, respectively). Abnormal ABI, not baPWV, independently predicted the presence of moderate (adjusted odds ratio, aOR: 2.18, 95% CI: 1.31–3.63) to severe (aOR: 5.59, 95% CI: 2.21–14.13) extracranial vessel stenosis and intracranial vessel stenosis (aOR: 1.89, 95% CI: 1.15–3.11). Neither the ABI nor baPWV was independently associated with SVD severity. (4) Conclusions: ABI is better than baPWV in screening for and identifying the existence of cerebral large vessel disease, but neither test is a good predictor of cerebral SVD severity.

Discussion

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Cite This Study

Chang et al. (2023) conducted a cohort in Acute ischemic stroke (n=820). Abnormal ankle-brachial index (ABI <0.9 or >1.4) and brachial-ankle pulse wave velocity (baPWV) vs. Normal ABI (0.9-1.4) and mild vessel stenosis reference group (<30% stenosis) was evaluated on Severe extracranial artery stenosis (≥70% diameter stenosis) (OR 5.59, 95% CI 2.21-14.13, p=<0.001). Abnormal ankle-brachial index independently predicted moderate to severe extracranial and severe intracranial artery stenosis in acute ischemic stroke patients.

synapsesocial.com/papers/6a7da6310631e052c4b87118 https://doi.org/10.3390/diagnostics13081455

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The Association between Ankle–Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Association between Ankle–Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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