title: Low Ankle-Brachial Index is a Simple Physical Exam Sign Predicting Intracranial Atherosclerotic Stenosis in Ischemic Stroke Patients.
abstract: BACKGROUND
  The investigation of ischemic stroke etiology is commonly limited to the heart and extracranial vessels. Nevertheless, the diagnosis of intracranial stenosis may carry important therapeutic implications. The aims of this study were to determine the prevalence and clinical predictors of intracranial atherosclerotic stenosis (ICAS) in a sample of patients with ischemic stroke.
  
  
  METHODS
  Consecutive patients admitted to a university-based outpatient stroke clinic underwent CT angiography of the intracranial and extracranial brain vessels. Clinical, demographic, and laboratory characteristics were compared between patients with increasing levels of stenosis. Ankle-brachial index (ABI) was measured to quantify peripheral arterial disease, defined as an ABI less than or equal to .9. Multivariable ordinal logistic regression was constructed to predict increasing stenosis grades (none, 1%-49%-mild, 50%-69%-moderate, 70%-100%-severe).
  
  
  RESULTS
  We studied 106 subjects, mean age 62 ± 15 years, 54% female. ICAS was present in 38 (36%) patients: 19 (50%) mild, 7 (18%) moderate, and 12 (32%) severe. Of 74 patients where ABI was measured, low ABI was found more frequently with increasing ICAS severity (26%, 42%, 67%, and 89% of patients with none, mild, moderate, and severe ICAS, respectively). In univariable analysis, higher age, presence of diabetes, abdominal obesity, and low ABI correlated with increasing stenosis grades. In multivariable analysis, only low ABI remained independently associated with increasing stenosis grades.
  
  
  CONCLUSIONS
  The ABI is independently associated with increasing severity of ICAS, making it a potentially useful triaging tool for more invasive test selection.
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil. Electronic address: nestorbarreto.med@gmail.com.
authors.forename: Nestor
authors.initials: N
authors.lastname: Barreto-Neto
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Alexandre D
authors.initials: AD
authors.lastname: Barros
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Pedro A P
authors.initials: PA
authors.lastname: Jesus
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Carolina C
authors.initials: CC
authors.lastname: Reis
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Morgana L
authors.initials: ML
authors.lastname: Jesus
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Isadora L O
authors.initials: IL
authors.lastname: Ferreira
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Rodrigo D
authors.initials: RD
authors.lastname: Fernandes
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Lucas L
authors.initials: LL
authors.lastname: Resende
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Alisson L
authors.initials: AL
authors.lastname: Andrade
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Beatriz M
authors.initials: BM
authors.lastname: Gonçalves
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Lais M B
authors.initials: LM
authors.lastname: Ventura
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Adriano A
authors.initials: AA
authors.lastname: Jesus
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Luana F
authors.initials: LF
authors.lastname: Fonseca
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Mila C
authors.initials: MC
authors.lastname: Mueller
authors.affiliation: Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001938:Brazil / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology
keywords: CT angiography; Ischemic stroke; ankle-brachial index; extracranial arterial stenosis; intracranial arterial stenosis