Department of Neurology, National Hospital Organization, Tokyo National Hospital, Kiyose, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):825-31. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.016. Epub 2011 Jun 23.
Patients with symptomatic peripheral artery disease (PAD) have an elevated prevalence of internal carotid artery (ICA) stenosis and cerebral infarction, although the correlations between the severity of PAD and cerebral infarction, cerebral white matter lesion (WML), or intracranial or extracranial artery stenosis are unclear.
We evaluated the prevalence of cardiovascular risk factors, cerebral infarction, and WML on magnetic resonance imaging and intracranial and extracranial carotid artery stenoses on magnetic resonance angiography in patients with symptomatic PAD (n = 136; males/females [M/F] 109/27) and a control group comprised of patients without PAD (n = 92; M/F 57/35). PAD was classified by Fontaine stage (stage II, n = 46; stage III, n = 20; stage IV, n = 70). Cerebral infarctions were classified into symptomatic or asymptomatic groups. WMLs were evaluated according to Fazekas stage. Artery stenosis was classified as normal (no stenosis), mild (stenosis <50%), moderate (stenosis ≥ 50%), severe (tight stenosis), and obstruction on magnetic resonance angiography.
Diabetes mellitus (DM), dyslipidemia, coronary artery disease (CAD), and chronic kidney disease (CKD), as well as symptomatic cerebral infarction and WML, were more frequent in patients with Fontaine III/IV PAD than without PAD. The prevalence rates of cerebral infarction and WML in patients with Fontaine stage II PAD were between those of the control and Fontaine III/IV PAD patients. Supraclinoid and cervical ICA stenoses (>50%) were more frequent in patients with Fontaine stage IV PAD than without PAD.
Our results indicate that patients with advanced PAD have an increased prevalence of symptomatic cerebral infarction, WML, and intracranial and cervical ICA stenosis as well as DM, CAD, and CKD.
有症状的外周动脉疾病（PAD）患者存在较高的颈内动脉（ICA）狭窄和脑梗死发生率，尽管 PAD 的严重程度与脑梗死、脑白质病变（WML）或颅内或颅外动脉狭窄之间的相关性尚不清楚。
我们评估了有症状 PAD 患者（n = 136；男/女 [M/F] 109/27）和无 PAD 对照组患者（n = 92；M/F 57/35）的心血管危险因素、脑梗死和磁共振成像上的 WML 患病率，以及颅内和颅外颈动脉狭窄磁共振血管造影上的患病率。PAD 按 Fontaine 分期（Ⅱ期，n = 46；Ⅲ期，n = 20；Ⅳ期，n = 70）进行分类。脑梗死分为症状性或无症状性。WML 根据 Fazekas 分期进行评估。磁共振血管造影上的动脉狭窄分为正常（无狭窄）、轻度（狭窄 <50%）、中度（狭窄≥50%）、重度（严重狭窄）和闭塞。
与无 PAD 患者相比，Fontaine Ⅲ/Ⅳ期 PAD 患者更常患有糖尿病（DM）、血脂异常、冠心病（CAD）和慢性肾脏病（CKD），以及有症状的脑梗死和 WML。Fontaine Ⅱ期 PAD 患者的脑梗死和 WML 患病率介于对照组和 Fontaine Ⅲ/Ⅳ期 PAD 患者之间。与无 PAD 患者相比，Fontaine Ⅳ期 PAD 患者的颈内动脉虹吸段和颈段狭窄（>50%）更为常见。
我们的结果表明，患有晚期 PAD 的患者有更高的症状性脑梗死、WML 以及颅内和颈内动脉狭窄的发生率，以及 DM、CAD 和 CKD。
