Stroke in Patients With Peripheral Artery Disease

Abstract

Background and Purpose— Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods— EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were performed using baseline characteristics to determine factors associated with all-cause stroke in patients with PAD. Results— A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively. Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index <0.60, prior amputation, and systolic blood pressure were independent baseline factors associated with the occurrence of all-cause stroke. After adjustment for baseline factors, the rates of ischemic stroke and all-cause stroke remained lower in patients treated with ticagrelor as compared with those receiving clopidogrel. There was no significant difference in the incidence of hemorrhagic stroke or TIA between the 2 treatment groups. Conclusions— In patients with symptomatic PAD, ischemic stroke and TIA occur frequently over time. Comorbidities such as age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, higher blood pressure, prior amputation, lower ankle-brachial index, and geographic region were each independently associated with the occurrence of all-cause stroke. Use of ticagrelor, as compared with clopidogrel, was associated with a lower adjusted rate of ischemic and all-cause stroke. Further study is needed to optimize medical management and risk reduction of all-cause stroke in patients with PAD. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01732822.

Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients

“…Previous studies have suggested that the risks of stroke and transient ischaemic attack are significantly increased in patients with PAD. 24 However, the association between PAD severity quantified by ABI and CAS is not clear. A prior study involving 5224 Chinese people reported that the proportion of patients with ABI ≤0.9 was higher in the CAS population than in the non-CAS population, suggesting that a low ABI is a significant risk factor for ACAS in male and older adults.…”

Multispectral optoacoustic tomography of peripheral arterial disease based on muscle hemoglobin gradients—a pilot clinical study

“…In this pilot study, we employed clinical MSOT hybridized with conventional ultrasound as a novel imaging technique for PAD assessment and therapy evaluation. PAD is a serious condition, that carries a substantial morbidity and is additionally considered to be an indicator for coronary artery disease and stroke (24,25). PAD affects more than 200 million people worldwide (26), with significant restraints in life quality and huge healthcare costs.…”

Association of the Prognosis of Ankle-brachial Index Improvement One Year Following Endovascular Therapy in Patients with Peripheral Artery Disease: Data from the I-PAD NAGANO Registry

“…As a secondary endpoint, the incidence of stroke differed markedly between the two groups. It has been reported that 2.4% of patients with PAD had ischemic stroke over a period of 30 months ( 15 ). Furthermore, when the baseline ABI value was <0.60, the hazard ratio was 1.309.…”