Stroke in Patients With Peripheral Artery Disease

Area of Science:

• Cardiovascular Medicine
• Neurology
• Clinical Trials

Background:

• Peripheral artery disease (PAD) is associated with a high risk of cerebrovascular events, but predictors remain poorly understood.
• Understanding stroke and transient ischemic attack (TIA) risk in PAD patients is crucial for effective management.
• Existing research has not fully elucidated the factors contributing to stroke in this population.

Purpose of the Study:

• To determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD.
• To identify independent predictors of stroke in patients diagnosed with PAD.
• To compare the stroke rates between patients treated with ticagrelor versus clopidogrel.

Main Methods:

• The EUCLID trial randomized 13,885 symptomatic PAD patients to ticagrelor or clopidogrel monotherapy.
• Cerebrovascular events (stroke, TIA) were adjudicated and analyzed for incidence and cumulative rates.
• Post hoc analyses used baseline characteristics to identify predictors of all-cause stroke via competing risk models.

Main Results:

• Over 30 months, 458 cerebrovascular events occurred, including ischemic strokes, hemorrhagic strokes, and TIAs.
• Independent predictors of all-cause stroke included age, prior stroke, atrial fibrillation/flutter, diabetes, geographic region, low ankle-brachial index (<0.60), prior amputation, and systolic blood pressure.
• Ticagrelor use was associated with lower adjusted rates of ischemic and all-cause stroke compared to clopidogrel; no significant difference in hemorrhagic stroke or TIA incidence was observed between groups.

Conclusions:

• Ischemic stroke and TIA are common in patients with symptomatic PAD.
• Multiple comorbidities and clinical factors independently predict stroke risk in PAD patients.
• Ticagrelor demonstrated a potential benefit in reducing ischemic and all-cause stroke rates compared to clopidogrel in this patient cohort.