Peripheral Arterial Atherosclerosis in Patients with Extracranial, not Intracranial, Arterial Stenosis

BACKGROUND: It is not known whether stroke patients with intracranial stenosis often have lower extremity atherosclerosis. The aim of our study was to elucidate this issue. METHODS: Consecutive stroke patients who had cerebral angiography were prospectively enrolled in this study. Cerebral artery and lower extremity artery stenoses were evaluated simultaneously using conventional angiography. To investigate sub-clinical arteriosclerosis, duplex ultrasonography was performed to assess the maximal intima media thickness (IMT) of the common carotid artery (CCA) and the femoral artery, and the ankle brachial pressure index (ABI) was determined. The patients were classified into three groups based on the cerebral angiographic findings: 1) IS group, with a > or = 50% stenosis of the intracranial artery; 2) ES group, with a > or = 50% of the extracranial carotid artery; 3) NS group, with no stenosis. We compared the IMT of the CCA and the femoral artery, as well as the ABI, among the three groups. RESULTS: A total of 81 patients (mean age 63 +/- 13 years old; 61 males) were enrolled. The prevalence of hypertension was greatest in the ES group. The maximal IMT of the femoral artery was highest in the ES group (ES group, 2.1 +/- 1.0 mm; IS group, 1.5 +/- 0.7 mm; NS group, 1.7 +/- 0.9 mm; p=0.043). The ES group had the lowest ABI (ES group, 1.00 +/- 0.24; IS group, 1.11 +/- 0.17; NS group, 1.13 +/- 0.15, p=0.031). CONCLUSION: The presence of sub-clinical atherosclerosis of the lower extremity arteries differed between patients with intracranial and extracranial stenosis. The mechanism of atherosclerosis may differ between intracranial and extracranial internal carotid artery.