[Detection of silent peripheral arterial disease in stroke patients with a low ankle-arm index]. / Detección mediante el índice tobillo-brazo de enfermedad arterial periférica silente en pacientes con ictus isquémico.

INTRODUCTION: A low ankle-arm index (AAI) is a strong predictor of vascular events and stroke. Nevertheless few studies have prospectively determined AAI in stroke patients. We aimed to investigated the prevalence of low AAI in stroke patients and which variables are associated with abnormal AAI. METHODS: Clinical data and ultrasonographic findings were collected in 79 consecutive stroke patients (20 transient ischemic attacks and 59 cerebral < ischemic infarction). During admission, AAI was measured in all subjects with the Doppler. An AAI cutoff of 0.90 was used to categorize individuals (< or =0.90: abnormal). RESULTS: A low AAI was calculated in 16 (20.3%) patients. AAI < or = 0.90 was associated with hypertension, smoking, hypercholesterolemia, coronary disease, previous peripheral arterial disease, male gender, internal carotid stenosis>50% (p<0.10). The presence of peripheral artery disease varied between subtypes. The incidence was higher for large artery atherosclerosis, 25.0 % and small vessel disease (31.5%). Multivariate analyses (logistic regression) only identify the association of>3 risk factors as independent predictor of low AAI (odds ratio: 4.41; confidence interval 95%: 1.39-4.01; p=0.012). CONCLUSION: Stroke patients had higher incidence of low AAI. Abnormal AAI was associated with classical risk factors. Existence of silent peripheral arterial disease in these patients may be an indicator of cerebral atherosclerosis extension. The measurement of AAI may be useful in order to plan adequate prevention therapies.

Detección mediante el índice tobillo-brazo de enfermedad arterial periférica silente en pacientes con ictus isquémico / Detection of silent peripheral arterial disease in stroke patients with a low ankle-arm index

Introducción. Un índice tobillo-brazo bajo (ITB) es un predictor de episodios vasculares, entre ellos los isquémicos cerebrales. Pese a ello casi no existen estudios sobre la incidencia de ITB anormales en pacientes con ictus isquémico. El objetivo del estudio es determinar la prevalencia y las variables clínicas asociadas a ITB bajo. Métodos. Estudiamos de forma consecutiva a 79 pacientes con un ictus isquémico (20 ataques isquémicos transitorios y 59 infartos cerebrales). Se recogieron datos clínicos y ultrasonográficos. Durante el ingreso se determinó mediante doppler el ITB. Se consideró como patológico un ITB <= 0,9. Resultados. Se observó un ITB<=0,9 en 16 (20,3 %) casos. El ITB patológico se asoció a antecedentes de hipertensión arterial, tabaquismo, dislipemia, cardiopatía isquémica, enfermedad arterial periférica, sexo varón y estenosis carotídea >50% (p < 0,10). El ITB bajo fue más frecuente en pacientes con ictus lacunar (31,5 %) o ateromatoso (25,0 %). En el análisis multivariante (regresión logística) la acumulación de más de tres factores de riesgo vascular se comportó como único predictor independiente de ITB <= 0,9 (odds ratio: 4,41; intervalo de confianza del 95 %: 1,39-14,01; p = 0,012). Conclusión. Existe un alto porcentaje de ITB bajo en pacientes con ictus isquémico. El ITB patológico se asocia a la presencia de factores de riesgo vascular clásicos. La existencia de enfermedad arterial periférica silente en estos pacientes podría traducir una extensión del proceso aterosclerótico cerebral. La determinación del ITB podría condicionar la elección del tratamiento de prevención secundaria más adecuado

Introduction. A low ankle-arm index (AAI) is a strong predictor of vascular events and stroke. Nevertheless few studies have prospectively determined AAI in stroke patients. We aimed to investigated the prevalence of low AAI in stroke patients and which variables are associated with abnormal AAI. Methods. Clinical data and ultrasonographic findings were collected in 79 consecutive stroke patients (20 transient ischemic attacks and 59 cerebral < ischemic infarction). During admission, AAI was measured in all subjects with the Doppler. An AAI cutoff of 0.90 was used to categorize individuals (<=0.90: abnormal). Results. A low AAI was calculated in 16 (20.3%) patients. AAI <= 0.90 was associated with hypertension, smoking, hypercholesterolemia, coronary disease, previous peripheral arterial disease, male gender, internal carotid stenosis>50% (p<0.10). The presence of peripheral artery disease varied between subtypes. The incidence was higher for large artery atherosclerosis, 25.0 % and small vessel disease (31.5%). Multivariate analyses (logistic regression) only identify the association of>3 risk factors as independent predictor of low AAI (odds ratio: 4.41; confidence interval 95%: 1.39-4.01; p=0.012). Conclusion. Stroke patients had higher incidence of low AAI. Abnormal AAI was associated with classical risk factors. Existence of silent peripheral arterial disease in these patients may be an indicator of cerebral atherosclerosis extension. The measurement of AAI may be useful in order to plan adequate prevention therapies