title: The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke.
abstract: BACKGROUND
  About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers.
  
  
  METHODS
  The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events.
  
  
  RESULTS
  Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p<0.001) were independently associated with an increased risk of vascular events. Neither isolated ICA stenosis >50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population.
  
  
  CONCLUSIONS
  Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke.
authors.affiliation: Department of Neurology, Hospital Universitario Dr. Josep Trueta, IdIBGi (Institut d'Investigació Biomèdica de Girona), 17007, Girona, Spain. jserena.girona.ics@gencat.cat.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Serena
authors.affiliation: Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. tsmtsm08@yahoo.es.
authors.forename: Tomás
authors.initials: T
authors.lastname: Segura
authors.affiliation: Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain. JRoquer@parcdesalutmar.cat.
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
authors.affiliation: Institut d'Investigació en Atenció Primària (IDIAP Jordi Gol), Girona, Spain. mgarcia@idiapjgol.info.
authors.forename: María
authors.initials: M
authors.lastname: García-Gil
authors.affiliation: Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain. jose.castillo@usc.es.
authors.forename: José
authors.initials: J
authors.lastname: Castillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology*; D055109:Ankle Brachial Index; D001794:Blood Pressure; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D018615:Ultrasonography, Doppler, Color