Li Z, Liu J
The Third Hospital of Hebei Medical University, Shijiazhuang, China -
Int Angiol. 2014 Oct;33(5):461-5.
Low ankle-brachial index (ABI<0.9) is considered a risk factor for stroke. However, there are disputes regarding the relationship between low ABI and intra-cranial atherosclerosis. The relationship between low ABI and intra/extracranial atherosclerosis was analyzed in the present study.
Patients with large artery atherosclerosis (LAA) and small artery disease (SAD) were enrolled in this study according to the classic Trial of ORG 10172 in Acute Stroke Treatment (TOAST) subtypes. Subjects were divided into three groups: intracranial atherosclerosis (IAS), extracranial atherosclerosis (EAS) and the small artery disease group. All of the enrolled patients underwent ABI measurement and were assessed for risk factors. The association between low ABI (<0.9) and extra/intra cranial atherosclerosis were examined using logistic regression.
Altogether, 31.51% of LAA patients were diagnosed with peripheral artery disease, which was much higher than that of the SAD patients (19.75%, P=0.045). There was a remarkable difference in the prevalence of abnormal ABI in the EAS stenosis and IAS stenosis patients (47.17% vs. 22.31%, P=0.001). Multivariable logistic regression identified peripheral artery disease (OR=2.759, 95% CI: 1.485-5.124) and smoking (OR=2.032, 95%CI:1.093-3.779) as independent risk factors for EAS stenosis. However hypertension (OR=1.957, 95%CI: 1.119-3.421) as well as male sex (OR=2.024, 95%CI: 1.251-3.274) were found to be independent risk factors for IAS stenosis. Peripheral artery disease was not associated with IAS stenosis (OR=1.075, 95%CI: 0.516-2.238).
Intracranial atherosclerosis was not associated with a low ABI (<0.9) in the stroke patients. Low ABI is significantly associated with age (>65 years), extra-cranial atherosclerotic and diabetes mellitus. Among ischemic stroke patients, a low ABI can be useful in predicting EAS.
踝臂指数低（ABI<0.9）被认为是中风的危险因素。然而，关于低ABI与颅内动脉粥样硬化之间的关系存在争议。本研究分析了低ABI与颅内/颅外动脉粥样硬化之间的关系。
根据经典的急性中风治疗ORG 10172试验（TOAST）亚型，纳入大动脉粥样硬化（LAA）和小动脉疾病（SAD）患者。受试者分为三组：颅内动脉粥样硬化（IAS）组、颅外动脉粥样硬化（EAS）组和小动脉疾病组。所有纳入的患者均进行ABI测量并评估危险因素。采用逻辑回归分析低ABI（<0.9）与颅外/颅内动脉粥样硬化之间的关联。
总共，31.51%的LAA患者被诊断患有外周动脉疾病，这远高于SAD患者（19.75%，P=0.045）。EAS狭窄和IAS狭窄患者中ABI异常的患病率存在显著差异（47.17%对22.31%，P=0.001）。多变量逻辑回归确定外周动脉疾病（OR=2.759，95%CI：1.485-5.124）和吸烟（OR=2.032，95%CI：1.093-3.779）是EAS狭窄的独立危险因素。然而，高血压（OR=1.957，95%CI：1.119-3.421）以及男性（OR=2.024，95%CI：1.251-3.274）被发现是IAS狭窄的独立危险因素。外周动脉疾病与IAS狭窄无关（OR=1.075，95%CI：0.516-2.238）。
中风患者中颅内动脉粥样硬化与低ABI（<0.9）无关。低ABI与年龄（>65岁）、颅外动脉粥样硬化和糖尿病显著相关。在缺血性中风患者中，低ABI可用于预测EAS。
