title: Increased pulsatility of the intracranial blood flow spectral waveform on transcranial Doppler does not point to peripheral arterial disease in stroke patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Electronic address: kristian.barlinn@uniklinikum-dresden.de.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: 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.
authors.forename: Stanislava
authors.initials: S
authors.lastname: Kolieskova
authors.affiliation: Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama.
authors.forename: Reza Bavarsad
authors.initials: RB
authors.lastname: Shahripour
authors.affiliation: Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama Hospital, Birmingham, Alabama.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.affiliation: Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
authors.affiliation: Department of Vascular Surgery, University of Alabama Hospital, Birmingham, Alabama.
authors.forename: William D
authors.initials: WD
authors.lastname: Jordan
authors.affiliation: Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial
keywords: Stroke; intracranial disease; peripheral arterial disease; transcranial Doppler