Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):782-9. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.006. Epub 2011 May 18.
There are limited data regarding abnormal ankle brachial index (ABI) with coexistent extracranial carotid stenosis (ECS), intracranial stenosis (ICS), and nonstenotic cervical atherosclerosis (CAS) in stroke, especially in Asia.
We studied the prevalence of ECS, ICS, CAS, and combined ECS and ICS in 756 Thai patients with acute ischemic stroke and correlated sites of atherosclerosis with stroke risk factors and abnormal ABI.
The prevalence of ECS was 8.8%, ICS 52.6%, CAS 36.0%, abnormal ABI 18.8%, combined ECS and ICS 4.6%, combined ECS and abnormal ABI 2.8%, combined ICS and abnormal ABI 10.6%, and combined ECS, ICS, and abnormal ABI 1.6%. The prevalence of ECS, CAS, and combined ECS and ICS was higher in abnormal ABI compared to normal ABI (14.8% v 7.5% [P = .006]; 46.5% v 33.5% [P = .004], and 8.4% v 3.7% [P = .016], respectively). ECS was significantly correlated with history of coronary artery disease (CAD) and abnormal ABI; ICS with male gender, no alcohol use, and no atrial fibrillation; CAS with age ≥ 60 years, history of CAD and abnormal ABI; and combined ECS and ICS with history of CAD.
The frequency of atherosclerosis, especially ICS, was high. Cervicocerebral atherosclerosis was higher in abnormal ABI. This suggests that ischemic stroke patients should be screened for ECS, CAS, ICS, and abnormal ABI, especially in specific subsets (age ≥ 60 years, male gender, and history of CAD). The improved identification of vascular lesions could allow for a more optimal choice of antithrombotics, neurointervention, and more aggressive control of risk factors, potentially improving prevention of disease progression and a decrease in recurrent vascular events.
在伴有颅外颈动脉狭窄（ECS）、颅内狭窄（ICS）和非狭窄性颈动脉硬化（CAS）的卒中患者中，异常踝臂指数（ABI）的数据有限，特别是在亚洲。
我们研究了 756 例泰国急性缺血性卒中患者中 ECS、ICS、CAS 和 ECS 与 ICS 并存的患病率，并将动脉粥样硬化部位与卒中危险因素和异常 ABI 相关联。
ECS 的患病率为 8.8%，ICS 为 52.6%，CAS 为 36.0%，ABI 异常为 18.8%，ECS 与 ICS 并存为 4.6%，ECS 与 ABI 异常并存为 2.8%，ICS 与 ABI 异常并存为 10.6%，ECS、ICS 和 ABI 异常并存为 1.6%。与正常 ABI 相比，异常 ABI 患者中 ECS、CAS 和 ECS 与 ICS 并存的患病率更高（14.8%比 7.5%[P =.006]；46.5%比 33.5%[P =.004]，8.4%比 3.7%[P =.016]）。ECS 与冠心病（CAD）和异常 ABI 显著相关；ICS 与男性、不饮酒和无房颤相关；CAS 与年龄≥60 岁、CAD 和异常 ABI 相关；而 ECS 与 ICS 并存与 CAD 相关。
动脉粥样硬化的频率较高，特别是 ICS。异常 ABI 患者中颈颅动脉粥样硬化程度更高。这表明，缺血性卒中患者应筛查 ECS、CAS、ICS 和异常 ABI，尤其是在特定亚组（年龄≥60 岁、男性和 CAD 病史）。对血管病变的识别提高，可以更优化地选择抗血栓药物、神经介入和更积极地控制危险因素，从而可能改善疾病进展的预防和减少复发性血管事件。
