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Background: Ankle-brachial index (ABI) is not only a marker of lower limb peripheral arterial disease (PAD), but may also reflect the severity of systemic atherosclerosis. Objectives: To study the prevalence of abnormal ABI among the studied patients with ischemic stroke compared to general population, to assess the correlation between the ABI abnormality and different risk factors, and to study the relationship between ABI abnormality and severity of stroke. Materials and methods: A case control observational analytical study for 200 patients, 100 patients with ischemic stroke and 100 patients as control group matched to case group in age and sex excluding patients with cardioembolic stroke, stroke of undetermined etiology, or young patients. We obtained ABI measurement from all participants. Criteria for PAD diagnosis is an ABI of < 0.9. We assessed patients' group using magnetic resonance imaging, transthoracic echocardiography, electrocardiography, carotid duplex, hemoglobin A1C, and lipid profile. Severity of stroke was assessed by the National Institute of Health Stroke Scale (NIHSS). Results and conclusion: Abnormal ABI relative frequency is higher in stroke group compared to controls. The risk factors most frequently associated with abnormal ABI are diabetes mellitus and dyslipidemia with high statistical significance. In our study, no single stroke patient with abnormal ABI who is not diabetic. In stroke patients, abnormal ABI is relatively more associated with carotid stenosis, recurrent stroke, small vessel disease stroke, and mild to moderate stroke severity by the NIHSS yet with no statistical significance for any of them.

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