Predictive value of ankle-brachial index and PAI-1 in symptomatic intracranial atherosclerotic disease recurrence

•73 Intracranial atherosclerotic disease first-ever stroke patients were studied.•Presence of new CVEs was assessed every six months.•Ankle-brachial index (ABI) and PAI-1 independently predict further strokes.•Discrimination power of ABI and ESRS improve in combination with PAI-1.

Background and purposeWe prospectively examine the single and combined predictive value of biological and clinical markers in recurrent strokes related to intracranial atherosclerotic disease (ICAD).MethodsIn 73 ICAD first-ever stroke patients, ankle-brachial index (ABI) was assessed three months after TIA or stroke together with CRP, Lp-PLA2, ICAM-1, E-selectin and PAI-1 measurements. Appearance of new TIA/stroke was assessed every 6 months.ResultsAfter a median follow-up of 22.4 months, 13 patients (17.8%) suffered a new stroke or TIA. Risk of new cerebrovascular events (CVEs) was associated with lowered ABI (p = 0.011), baseline PAI-1 > 22.52 ng/ml (<0.001), E-selectin > 24.75 ng/ml (p = 0.008) and ICAM-1 > 205 ng/ml (p = 0.029). The combination of PAI-1 with ABI or ESRS reclassified 55.4% (p < 0.005) and 48.3% (p < 0.05) of patients between low, high and very high-risk categories.ConclusionsThis tentative study shows that ABI and PAI-1 are associated with the risk of new CVEs in symptomatic ICAD patients, and their combination might improve identification of patients at higher risk.