Title: Study of Asymptomatic Peripheral Arterial Disease in Ischemic Stroke Patients and Associated Comorbid Conditions
Authors: Bhuwan Sharma, Surekha Dabla, Anubha Garg, Kapinder Yadav
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.20
Patients with stroke and patients with transient ischemic attack (TIA) are at high risk for vascular events and may not exhibit the signs and symptoms of peripheral arterial disease (PAD). We investigated prevalence of asymptomatic PAD detected by ankle brachial index <0.9 in patients with stroke and difference between risk factor profile between patient having asymptomatic PAD and those without asymptomatic PAD. In this cross sectional hospital-based study, asymptomatic PAD was detected by ankle brachial index measurement in consecutive 100 patients with stroke. They were assessed for stroke risk factors, ankle brachial index measurement, and laboratory parameters known to be associated with stroke risk. These data was compared between patient having asymptomatic PAD and those without asymptomatic PAD. Our study demonstrates that in patients with ischemic stroke, asymptomatic peripheral arterial disease is highly prevalent. These patients had significantly higher risk factors and risk of future athero-thrombotic events could be higher, so ABI measurement can be good non-invasive tool to identify patients with greater risk of future events and thereby help in optimizing secondary preventive measures. Key words: Stroke, Ankle brachial index, Peripheral arterial disease 1. Topakian R, Nanz S, Rohrbacher B, Koppensteiner R, Aichner FT; OECROSS Study Group. High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke. Cerebrovasc Dis. 2010; 29: 248 – 54. 2. 2011 Writing Group Members; 2005 Writing Committee Members; ACCA / AHA Task Force Members. 2011 ACCF / AHA Focused Update of the Guideline for the Management of patients with peripheral artery disease (Updating the 2005 Guideline): a report of the American College of Cardiology Foundation / American Heart Association Task Force on practice guidelines. Circulation 2011; 124: 2020 – 45. 3. Ankle Brachial Index Collaboration, Fowkes FG et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008; 300: 197 – 208. 4. Feringa HH, Bax JJJ, vanWaning VH. The long-term prognostic value of the resting and post exercise ankle-brachial index. Arch Intern Med 2006; 166: 529–35. 5. Adam HP, Bendixen BH, Kapelle LJ. Classification of subtypes of acute ischemic stroke,definition for use in a multicentral trial. Stroke 1993;24;35-41. 6. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FGR, Hiatt WR, Jo¨nsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux P-M, Stoffers HE, Treat-Jacobson D, on behalf of the American Heart Association Council on Peripheral Vascular Disease, Council on Epidemiology and Prevention, Council on Clinical Cardiology, Council on Cardiova-scular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126. 7. Weimar C, Goertler M, Rother J, Ringelstein EB, Darius H. Systemic risk score evaluation in ischemic stroke patients (SCALA): a prospective cross sectional study in 85 German stroke units. J Neurol 2007;254:1562–68. 8. Sauvik sen et al.Association of Asymptomatic Peripheral Arterial Disease With Vascular Events in Patients With Stroke or Transient Ischemic Attack . Stroke. 2009;40:3472-77. 9. Rehman A et al. association of ankle brachial index in patients with ischemic stroke: A case control study.Chattagram maa-o-shishu hospital journal;12. 10. Busch et al. Low ankle brachial index predicts cardiovascular risk after acute ischemic stroke or transient ischemic attack. Stroke 2009;40:3700-05. 11. Nakano et al. measurement of ankle brachial index for the assessment of atherothrombosis in patients with stroke: cerebrovascular dis 2004.17:212-14 12. Banerjee A, Fowkes FG, Rothwell PM.association between peripheral artery disease and ischemic stroke implication for primary and secondary prevention.stroke 2010;41:2102-7. 13. Hoshino et al. Prevalence and Clinical Features of Asymptomatic Peripheral Artery Disease in Japanese Stroke Patients. JStroke Cerebrovasc Dis 2013; 22: 255-59. 14. Chung et al. differences of ankle brachial index according to ischemic stroke subtypes:The peripheral artery disease in Korean patients with ischemic stroke(PIPE )study. Eur Neurol 2013;69:179-84. 15. Gresham GE, Fitzpatric TE, Wolf PA .Residual disability in survivors of stroke-The Framingham study. N Engl J Med 1975:293:454-56. 16. Purroy F, Coll B, Oro M, et al. Predictive value of ankle brachial index in patients with acute ischaemic stroke. Eur J Neurol 2010;17:602-06 17. Sawayama Y, Hamada M, Otaguro S. The impact of peripheral arterial disease and acute ischemic stroke. Fukuoka Acta Med 2006;97:293-301.Abstract
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