Analysis of the Characteristics of Peripheral Artery Disease in Patients with Hemiplegia After Ischemic Stroke and Their Mid- and Long-Term Outcomes.

The purpose of this study was to investigate the onset characteristics of peripheral artery disease (PAD) in patients with hemiplegia after ischemic stroke as well as their mid- and long-term prognosis following surgical intervention. This was a retrospective controlled study. In this study, the clinical data for 113 patients with post-stroke hemiplegia combined with PAD (defined as hemiplegia + PAD [HP]) and 68 PAD patients without stroke (Control) who were admitted in a single institution between March 2015 and December 2021 were analyzed. Among 113 patients, 68 had undergone surgical intervention and the hemiplegic and PAD sides were consistent. Subsequently, a 1:1 propensity score matching was performed to match these 68 surgically treated HP patients with 68 counterparts in the control group. The primary outcomes of this study included consistency (Kappa) between the hemiplegic limb and the PAD limb, preoperative and postoperative changes in ankle brachial index (ABI), primary patency rate, clinically driven target lesion revascularization (CD-TLR) rate and survival rate. Among the HP patients, computed tomography measurements revealed that the diameter of the common femoral artery at the femoral head level was significantly smaller in the hemiplegic limb than in the nonhemiplegic limb (P < 0.001), Additionally, the ABI of the hemiplegic limb was significantly lower than that of the nonhemiplegic limb (P < 0.001) and the Global Limb Anatomic Staging System classification of the hemiplegic limb were significantly higher than those of the nonhemiplegic limb (P < 0.001). Furthermore, there was a high level of consistency between the hemiplegic limb and the limb affected by PAD among HP patients, with a Kappa coefficient of 0.709 (95% confidence interval: 0.572-0.846, P < 0.001). The median follow-up times of surgical treatment and the hemiplegic limb is consistent with the PAD-affected limb (S•HPC) patient, control group patients and surgical treatment and the hemiplegic limb is nonconsistent with the PAD-affected limb patients were 44.7 ± 23.3 months, 45.3 ± 23.0 months and 30.8 ± 22.9 months, respectively. Moreover, the primary patency rate and the freedom from CD-TLR rate of S•HPC patients were lower than those of control group (P = 0.005 and 0.043, respectively); the postoperative survival rate of S•HPC patients was lower than that of the control group (60.1 ± 4.1% vs. 74.4 ± 3.2%, P = 0.010). In patients with postischemic stroke hemiplegia complicated by PAD, the lower-extremity arterial blood flow (ABI) was significantly reduced on the hemiplegic side compared with the nonhemiplegic side; furthermore, PAD was more likely to occur on the hemiplegic side. In addition, compared to PAD patients without a history of ischemic stroke, patients with ischemic stroke, concurrent PAD, and ipsilateral hemiplegia exhibited a lower primary patency rate, freedom from CD-TLR rate and survival rate after surgical intervention.