Abstract
Ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are widely used noninvasive modalities to evaluate atherosclerosis. Recently, evidence has increased supporting the use of ABI and baPWV as markers of cerebrovascular disease. This study sought to examine the relationship between ABI and baPWV with ischemic stroke. This study also aimed to determine which pathogenic mechanism, large artery disease (LAD) or small vessel disease (SVD), is related to ABI or baPWV. Retrospectively, 121 patients with ischemic stroke and 38 subjects with no obvious ischemic stroke history were recruited. First, ABI and baPWV were compared between the groups. Then, within the stroke group, the relevance of ABI and baPWV with regard to SVD and LAD, which were classified by brain magnetic resonance image (MRI) and magnetic resonance angiography (MRA) or computed tomography angiography (CTA) findings, was assessed. The baPWV was higher in the stroke group than non-stroke group (1,944.18±416.6 cm/s vs. 1,749.76±669.6 cm/s, P<0.01). Regarding LAD, we found that mean ABI value was lower in the group with extracranial large artery stenosis (P<0.01), and there was an inverse linear correlation between ABI and the grade of extracranial large artery stenosis (P<0.01). For SVD, there was a significant correlation between SVD and baPWV (2,057.6±456.57 cm/s in the SVD (+) group vs. 1,491±271.62 cm/s in the SVD (-) group; P<0.01). However, the grade of abnormalities detected in SVD did not correlate linearly with baPWV. These findings show that baPWV is a reliable surrogate marker of ischemic stroke. Furthermore, baPWV and ABI can be used to indicate the presence of small vessel disease and large arterial disease, respectively.
Highlights
Ischemic stroke is a heterogeneous disorder with several pathophysiological mechanisms[1]
In analysis of the relationship between ankle brachial index (ABI)/brachial-ankle pulse wave velocity (baPWV) and ischemic stroke, there was a positive correlation between the baPWV value and ischemic stroke
Because the majority of cerebral artery diseases are due to the development and progression of atherosclerosis, the use of noninvasive surrogate markers of atherosclerosis can aid in the diagnosis of cerebrovascular disease through the identification of subclinical cases
Summary
Ischemic stroke is a heterogeneous disorder with several pathophysiological mechanisms[1]. Atherosclerosis is one of the pathogenic mechanisms that can lead to ischemic stroke and cardiovascular disease. Carotid intima-media thickness (IMT), pulse wave velocity (PWV), flow-mediated dilation (FMD) of the brachial artery, and ankle brachial index (ABI) are widely used noninvasive modalities to evaluate atherosclerosis[2,3,4,5]. ABI is the ratio of blood pressure in the. Lower legs to blood pressure in arms which can readily be measured with Doppler. A low ABI is an independent marker for the presence of coronary artery disease in subjects with a high risk of atherosclerotic cardiovascular disease[6]. The subjects with low ABI had a significantly greater risk of developing stroke than those with normal values[7,8]
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