Key result
The presence of both internal carotid artery stenosis >50% and peripheral arterial disease was independently associated with an increased risk of vascular recurrence or death (HR 4.52) at 12 months.
Cohort (n=620)
Yes
The presence of symptomatic peripheral artery disease, particularly when combined with internal carotid artery stenosis >50%, strongly predicts the risk of recurrent vascular events in patients with a recent non-cardioembolic stroke.
May identify high-risk post-stroke patients for closer surveillance; leaves open whether targeted interventions improve outcomes.
BACKGROUND: About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers. METHODS: The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events. RESULTS: Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p<0.001) were independently associated with an increased risk of vascular events. Neither isolated ICA stenosis >50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population. CONCLUSIONS: Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke.
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Serena et al. (2015) conducted a cohort in First non-cardioembolic stroke (n=620). Peripheral arterial disease (PAD) and internal carotid artery (ICA) stenosis >50% vs. Normal ankle brachial index and ICA stenosis <50% was evaluated on Death or major cardiovascular events (HR 4.52, 95% CI 2.14-9.53, p=<0.001). The presence of both internal carotid artery stenosis >50% and peripheral arterial disease was independently associated with an increased risk of vascular recurrence or death (HR 4.52) at 12 months.
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