Naito Hiroyuki, Naka Hiromitsu, Kobayashi Megumi, Kanaya Yuhei, Naito Kasane, Kurashige Takashi, Tokinobu Hiroshi, Matsumoto Masayasu
Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1128-1134. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.029. Epub 2016 Feb 22.
Few studies have examined the prevalence of peripheral arterial disease (PAD) with the use of computed tomography angiography (CTA) in patients with acute ischemic stroke (AIS), although several reports have examined its prevalence using an ankle brachial index (ABI). We aimed to determine the prevalence of PAD indicated by CTA in patients with AIS and to clarify the prevalence of PAD in each clinical ischemic stroke subtype.
We included 199 consecutive patients with AIS admitted to our hospital and divided them into PAD and non-PAD groups according to the CTA findings.
Of the 199 patients, 40 (20.1%) had PAD; 27 (67.5%) of the PAD patients were asymptomatic. The prevalence of abnormal ABI (≤.9) was 12.2%. Patients with PAD were older (78.3 ± 10.2 versus 71.5 ± 10.9, P <.001) and had a significantly lower ABI value (.89 ± .24 versus 1.15 ± .09, P <.001) and higher prevalence of diabetes mellitus (50.0% versus 31.4%, P = .028), atrial fibrillation (40.0% versus 16.4%, P = .001), coronary artery disease (32.5% versus 8.2%, P <.001), and intracranial arterial stenosis (47.5% versus 28.9%, P = .025) than patients without PAD. The prevalence of cerebral microbleeds was not different between patients with PAD and those without PAD (25.6% versus 25.4%, P = .985). The prevalence of PAD among ischemic stroke subtypes was highest in patients with cardioembolic infarction (40.5%).
Almost one fourth of the AIS patients examined had PAD on CTA. Cardioembolic infarction patients showed the highest prevalence of PAD among the clinical ischemic subtypes, suggesting the coexistence of atheromatous diseases and atrial fibrillation.
尽管有几份报告使用踝臂指数（ABI）检查了急性缺血性卒中（AIS）患者外周动脉疾病（PAD）的患病率，但很少有研究使用计算机断层扫描血管造影（CTA）来检查其患病率。我们旨在确定AIS患者中CTA显示的PAD患病率，并阐明每种临床缺血性卒中亚型中PAD的患病率。
我们纳入了我院收治的199例连续的AIS患者，并根据CTA结果将他们分为PAD组和非PAD组。
在199例患者中，40例（20.1%）患有PAD；27例（67.5%）PAD患者无症状。异常ABI（≤0.9）的患病率为12.2%。PAD患者年龄更大（78.3±10.2岁对71.5±10.9岁，P<0.001），ABI值显著更低（0.89±0.24对1.15±0.09，P<0.001），糖尿病患病率更高（50.0%对31.4%，P=0.028），心房颤动患病率更高（40.0%对16.4%，P=0.001），冠状动脉疾病患病率更高（32.5%对8.2%，P<0.001），颅内动脉狭窄患病率更高（47.5%对28.9%，P=0.025）。PAD患者和非PAD患者脑微出血的患病率无差异（25.6%对25.4%，P=0.985）。在缺血性卒中亚型中，心源性栓塞性梗死患者的PAD患病率最高（40.5%）。
接受检查的AIS患者中近四分之一在CTA上显示有PAD。在心源性栓塞性梗死患者中，PAD在临床缺血性亚型中的患病率最高，提示动脉粥样硬化疾病和心房颤动并存。
