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Low Toe-Brachial Indices are Associated with Saccular Intracranial Aneurysms
Essi Kangas1,2, Ville Rantasalo1,2, Petra Korpisalo3
1Department of Surgery, University of Turku, Turku, Finland.
Vascular Health and Risk Management
|March 27, 2026
Summary
Low toe-brachial index (TBI), a marker for peripheral artery disease, is linked to a higher prevalence of unruptured intracranial aneurysms (IAs). This finding suggests a role for atherosclerosis in IA development.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Peripheral artery disease (PAD) and intracranial aneurysms (IAs) share risk factors like smoking and hypertension.
- Previous studies linked low ankle-brachial index (ABI) to increased IA prevalence.
- The toe-brachial index (TBI) is another non-invasive measure for PAD.
Purpose of the Study:
- To investigate the association between low toe-brachial index (TBI) and the prevalence of intracranial aneurysms (IAs).
- To determine if TBI can serve as a predictor for IA risk.
Main Methods:
- Retrospective cohort study of 2751 patients with TBI assessments.
- Included patients with available cerebrovascular imaging or diagnosed IAs (n=776).
- Stratified patients by TBI values: low (<0.5), borderline (0.50-0.69), and normal (≥0.7).
Main Results:
- Prevalence of unruptured IAs was significantly higher in the low TBI group (16.3%) compared to borderline (8.3%) and normal (4.1%) groups (p<0.001).
- Low TBI was independently associated with a 3.59-fold increased odds of unruptured IAs.
- Female sex and smoking history were also associated with higher IA prevalence.
Conclusions:
- Low TBI is associated with a fourfold higher prevalence of unruptured IAs, independent of other risk factors.
- Findings suggest a potential role of atherosclerosis in the pathogenesis of IAs.
- Further prospective studies are needed to confirm TBI's role in IA risk stratification.
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