Study Of The Relationship Among Ankle-Brachial Index And Risk Factors For Stroke And Intracranial Arterial Stenosis

Objective:To investigate the relationship among ankle-brachial index(ABI) and risk factors in ischemic stroke and intracranial arterial stenosis,and to evaluate the relationship among ABI and the extent and sites of intracranial arterial stenosis,and to oberserve the significance between ankle-brachial index(ABI) and recent cardiac and cerebrovascular incidents.Methods:Total 150 consecutive patients with ischemic stroke were enrolled during March in 2007 to April in 2008 at the First Affiliated Hospital of Dalian Medical University.According to North American Symptomtic Carotid Endarterectomy Trial (NASCET), all the patients with digital subtraction angiography (DSA) or computer tomography angiography (CTA) examination,were divided into four groups:normal group,slight stenosis group,midrange stenosis group and severe stenosis group.In all patients,25 patients were normal and 125 patients divided into different positions within the carotid artery system, of vertebrobasilar system, of the internal carotid artery system and vertebrobasilar systems (mixed) were narrow. All patients were examined by ankle-brachial index(ABI), and conventional risk factors of ischemic stroke such as age,gender,hypertension history, diabetes history,coronary artery diseases,atrial fibrilation, cerebrovascular diseases history,smoking and alcoholing history and plasma level of fasting blood glucose,cholesterol,triglyceride,low density lipoprotein cholesterol, high density lipoprotein cholesterol,homocysteic acid,C-reactive protein, stature, body weigh and waist circumference were evaluated. To ABI = 0.9 for the industry,all the patients were divided into normal ABI (ABI> 0.9) and abnormal ABI (ABI≤0.9). All patients were followed up six months of records in cardiovascular and cerebrovascular eventsResults:1. There were significant differences between normal group and narrow group in hypertension history,diabetes histroy,fasting blood glucose, LDL-C,ankle-brachial index (ABI),while gender,age,coronary artery diseases history,atrial fibrilation history,cerebrovascular diseases history, body mass index, smoking and alcoholing, waist-circumference, triglyceride, cholesterol,high-density lipoprotein cholesterol,homocysteic acid and C-reactive protein,were non-significant differences(P>0.05).Based on the multivariable stepwise logistic regression model,LDL-C and ankle brachial index(ABI) were independent risk factors for intracranial stenosis.2. In patients with stroke, the subjects were divided into four groups:normal group,slight stenosis group,midrange stenosis group and severe stenosis group.one-way ANOVA analysis showed that ABI reduced significantly (P <0.05) in the patients with severe stenosis in carotid artery. the difference among the three groups was not significant (P> 0.05).3. In the traditional various risk factors of stroke,ABI was significantly related to diabetes history,TG,LDL-C and FBG, Based on the multivariable stepwise logistic regression model, dyslipidemia (the ascending in CHOL,LDL-C and TG) was an independent predictor of the abnormal of ABI.In patients with stroke.4. In the patients with the intracranial arterial stenosis of carotid artery system and vertebrobasilar systems(mixed),ABI level marked significant difference from the normal group,carotid artery stenosis and vertebrobasilar stenosis group (P <0.001), but after, among the three groups ABI level was no significant difference (P> 0.05).5. All patients were followed up a telephone to six months in cardiovascular and cerebrovascular events (including death) for short-term prognosis observed, cardiovascular and cerebrovascular events were 34 cases, 116 cases did not occur, In the patients with ABI abnormal, heart and brain vascular incident was significantly higher than those in the nomal cases (P<0.05).Logistic regression analysis suggested the level of ABI and the history of high blood pressure (HBP) as independent predictor of the recent cardiovascular and cerebrovascular events (Cardiovascular and cerebrovascular events (including death) for the prognosis of indicators as the dependent variable,while gender, age, coronary heart disease, atrial fibrillation, hypertension, diabetes, history of smoking and drinking, the level of ABI and drug compliance as possible as were regarded as independent variable).The Equations: P=1/[1+e^{-(-9.032+10.945ABI-1.052HBP)}].Conclusions:1. LDL-C and ABI were probablly independent predictor in intracranial stenosis,and related to the extent of severe stenosis in intracranial artery.2. Abnormal of ABI was related to the intracranial arterial stenosis of carotid artery system and vertebrobasilar systems(mixed).3. Dyslipidemia was an independent predictor of the abnormal of ABI.4. The level of ABI and hypertension history(HBP) can predict recent prognosis of the cardiac and cerebrovascular incidents independently in patients with ischemic stroke.