Abstract
Background and Purpose: Though peripheral artery disease (PAD) is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD. This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow. The aim of this study is to compare outcomes after endovascular thrombectomy (EVT) in acute stroke patients with and without PAD and to assess the relation between PAD and collateral grades.Methods: We analyzed acute ischemic stroke patients treated with EVT for an anterior circulation large artery occlusion, included in the Dutch, prospective, multicenter MR CLEAN Registry between March 2014 and November 2017. Collaterals were scored on CT angiography, using a 4-point collateral score. We used logistic regression analysis to estimate the association of PAD with collateral grades and functional outcome, assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included mortality at 90 days, symptomatic intracranial hemorrhage, and stroke progression.Results: We included 2,765 patients for analysis, of whom 254 (9.2%) had PAD. After adjustment for potential confounders, multivariable regression analysis showed no association of PAD with functional outcome [mRS cOR 0.90 (95% CI, 0.7–1.2)], collateral grades (cOR 0.85, 95% CI 0.7–1.1), or safety outcomes.Conclusion: In the absence of an association between the presence of PAD and collateral scores or outcomes after EVT, it may be questioned whether PAD leads to RIPC in patients with acute ischemic stroke due to large vessel occlusion.
Highlights
Patients with previous transient ischemic attacks seem to have smaller infarct sizes and better outcomes after subsequent cerebral infarction than patients without [1, 2]
The aim of our present study is [1] to investigate if preexistent peripheral artery disease (PAD) is associated with better functional outcome in acute stroke patients treated with endovascular thrombectomy (EVT), and [2] to investigate if PAD is correlated with collateral grades on CT angiography (CTA) before EVT
The extent of early ischemic lesions at baseline was significantly different between groups, in favor of patients with PAD (median Alberta stroke programme early CT score (ASPECTS) 9 (IQR 8–10) vs. 9 (IQR 7–10), p = 0.03)
Summary
Patients with previous transient ischemic attacks seem to have smaller infarct sizes and better outcomes after subsequent cerebral infarction than patients without [1, 2]. A randomized controlled trial in patients with ischemic stroke treated with intravenous thrombolysis demonstrated that RIPC induced by intermittently inflating a tourniquet on one of the limbs led to smaller perfusion deficits or DWI lesions [6]. This trial did not show effect on clinical outcome at 3 months. Though peripheral artery disease (PAD) is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow. The aim of this study is to compare outcomes after endovascular thrombectomy (EVT) in acute stroke patients with and without PAD and to assess the relation between PAD and collateral grades
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
