title: Cerebrovascular disease and intracranial artery stenosis in patients with symptomatic peripheral artery disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, National Hospital Organization, Tokyo National Hospital, Kiyose, Tokyo, Japan. hitoshi.aizawa@gmail.com
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Aizawa
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Azuma
authors.forename: Takayuki
authors.initials: T
authors.lastname: Katayama
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
authors.forename: Masashi
authors.initials: M
authors.lastname: Inaba
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Sasajima
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology*; D002539:Cerebral Arterial Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index