This is a prospective cohort study. One hundred cases with large artery ischemic stroke were recruited from Nasr City Insurance Hospital. Patients were subjected to clinical assessment including complete medical history (detailed history including personal data with a history of risk factors including hypertension, diabetes mellitus, dyslipidemia, smoking); general examination including signs suggestive of PAD; detailed neurological history, examination, and NIHSS at days 0, 7, and 30 for the assessment of stroke severity; follow-up for recurrence or death after 6 months; laboratory assessment full chemistry including full blood picture, liver and kidney functions, fasting and random blood sugar, PT, PTT, INR, lipid profile, collagen profile, protein C, protein S, and anti-thrombin III in cases of stroke in young without strong risk factors; imaging including trans-thoracic echocardiography (General electric Vivid 7, USA) and trans-esophageal echocardiography in cases of stroke in young without strong risk factors to exclude cardio-embolic strokes; Duplex on the arteries of both lower limbs; and measuring of ankle brachial index (ABI). The systolic pressure in the dorsalis pedis or posterior tibial artery was measured using a handheld 8-MHz Doppler probe (model Life Dop L250R with SD8 probe product by Summit Doppler, China) and a blood pressure cuff. The higher of these two measurements was compared with a similarly taken brachial artery systolic pressure. A ratio (ankle/brachial) of 0.9 or less is considered a sign of impaired flow to the extremity . MRI brain (diffusion-weighted, flair, T1, T2, and T2* images) and MRA (Philips 1.5 Tesla, Germany). Carotid duplex (General Electric Logic 5, USA) and/or C.T angiography brain and neck and/or conventional angiography if needed.
Inclusion criteria and subject selection
Stroke patients with large artery atherosclerotic disease either intra-cranial or extra-cranial and anterior circulation or posterior circulation verified by MRI and MRA brain or CT angiography on the neck and brain vessels or conventional angiography.
Patients were excluded from the study if they showed clinical evidence of cardio-embolic stroke as atrial fibrillation, transient ischemic attack, and intra-cerebral, subdural, or subarachnoid hemorrhage.
Data were analyzed using Stata® version 14.2 (StataCorp LLC, College Station, TX, USA). Normality of numerical data distribution was examined using the Shapiro-Wilk test. Non-normally distributed numerical data were presented as median and interquartile, and intergroup differences were compared using the Wilcoxon rank sum test (for two-group comparison) or the Jonckheere-Terpstra trend test (for comparison of multiple tanked grouped).
Categorical data were presented as the ratio or number and percentage, and intergroup differences were compared using Fisher’s exact test (for nominal data) or the chi-squared test for trend (for ordinal data). Associations among ordinal variables were tested using the Spearman rank correlation and Kendall’s tau-b.
A time-to-event analysis was done using the Kaplan-Meier (K-M) method. The log-rank test was used to compare individual K-M curves.
p value < .05 was considered statistically significant.