Barlinn Kristian, Kolieskova Stanislava, Shahripour Reza Bavarsad, Kepplinger Jessica, Boehme Amelia K, Siepmann Timo, Puetz Volker, Bodechtel Ulf, Jordan William D, Alexandrov Andrei V
Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic; Neurology Department, Masaryk University, Brno, Czech Republic.
J Stroke Cerebrovasc Dis. 2015 Jan;24(1):189-95. doi: 10.1016/j.jstrokecerebrovasdis.2014.08.014. Epub 2014 Nov 6.
Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia.
We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to .75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to .9 or more was considered predictive of definite PAD.
We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P = .60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR], .68; 95% CI, .22-2.12; P = .51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P = .002 and OR, 3.20; 95% CI, 1.51-6.77; P = .002, respectively).
Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.
外周动脉疾病（PAD）在急性脑缺血患者中很常见。经颅多普勒（TCD）诊断颅内动脉疾病时，通常使用由收缩期和舒张期速度得出的阻力指数。我们试图探讨这些指数是否能预测急性脑缺血患者中PAD的存在。
我们对连续的急性脑缺血患者进行了前瞻性评估。在TCD检查中，手动测量大脑中动脉和基底动脉的收缩期峰值速度和舒张期末期速度，以计算搏动指数（PI）和阻力指数（RI）。阻力增加定义为PI等于或大于1.2且RI等于或大于0.75。进行踝臂指数（ABI）测量，ABI等于或大于0.9被认为可预测明确的PAD。
我们纳入了95例患者（45例男性，50例女性），年龄66±9岁，美国国立卫生研究院卒中量表评分中位数为3分（四分位间距为8分）。95例患者中有24例（25.3%；95%置信区间[CI]，16.4 - 34.2）的ABI异常且与明确的PAD一致。有PAD和无PAD的患者之间PI升高无差异（20.8%对28.2%，P = 0.60）。只有1例PAD患者RI升高，而无PAD患者有4例（4.2%对5.6%，P = 1.0）。PI升高未被发现是PAD的独立预测因素（优势比[OR]，0.68；95% CI，0.22 - 2.12；P = 0.51）。PI和RI升高均独立预测动脉高血压（OR分别为1.62；95% CI，1.19 - 2.21；P = 0.002和OR，3.20；95% CI，1.51 - 6.77；P = 0.002）。
我们的研究结果表明，在急性脑缺血患者中，不能从预测动脉疾病的颅内血流参数以及高血压等危险因素推断出PAD。
