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Atherosclerosis. 2014 Mar;233(1):72-5. doi: 10.1016/j.atherosclerosis.2013.12.021. Epub 2014 Jan 4.

Ankle-brachial index in screening for asymptomatic carotid and intracranial atherosclerosis.

Author information

  • 1Department of Neurosciencies, Hospital Germans Trias i Pujol, Universitat Autónoma Barcelona, Badalona, Spain.
  • 2Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain.
  • 3Department of Neurology, Stroke Unit, Hospital Clínico Universitario, Valladolid, Spain.
  • 4Department of Neurosciencies, Hospital Germans Trias i Pujol, Universitat Autónoma Barcelona, Badalona, Spain. Electronic address:



To evaluate usefulness of ankle-brachial index (ABI) in the screening for asymptomatic cervico-cerebral atherosclerosis (CCA) against traditional vascular risk assessment.


This study included a random population sample of 933 Caucasians without prior cardiovascular disease but with a moderate and high vascular risk (REGICOR score 5-9% and ≥ 10%). Presence and degree of CCA was evaluated by color-coded duplex and significant stenosis >50% (SCCA) confirmed by MRA.


Prevalence of significant carotid and/or intracranial stenosis was 6% in the whole population, but increased up to 25% among those subjects with ABI ≤ 0.9 regardless of REGICOR score. Using REGICOR ≥ 10%, the likelihood ratio (LR) for the detection of SCCA was 1.8, while using ABI ≤ 0.90 the LR was 6.0. After multivariate regression analysis, low ABI was independently associated with SCCA whereas REGICOR score was not. Less than 40% of subjects with SCCA were taking antiplatelet drugs or statins at the moment of diagnosis.


ABI emerged as a useful and simple tool in identifying asymptomatic SCCA in our population. This finding may be important for improving stroke primary prevention strategies.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.


Carotid stenosis; Intracranial stenosis; Primary prevention; Subclinical atherosclerosis

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