Higher aortic-brachial pulse wave velocity ratio is associated with large artery atherosclerosis-related ischemic stroke.

Hypertension is one of the main modifiable risk factors for ischemic stroke related to large artery atherosclerosis. Arterial stiffness indices may improve risk stratification beyond blood pressure (BP) measurement alone. Increased pulse wave velocity (PWV) is a risk and prognostic factor for ischemic stroke (IS) and is associated with carotid artery atherosclerosis. We investigated whether the aortic-brachial pulse wave velocity (PWV) ratio differs between stroke subtypes and whether it is independent of mean blood pressure (MBP) in ischemic stroke patients. We measured carotid-radial (cr-PWV) and carotid-femoral PWV (cf-PWV) on day 6 of hospitalization in 188 IS subjects. PWV ratio was calculated as cf-PWV/cr-PWV. The etiology of stroke was determined following appropriate diagnostic investigations. Stroke etiology was determined according to TOAST classification. Associations between PWV ratio, stroke subtype, and MBP were analyzed using uni- and multivariate models. Forty-one patients (21.8%) had stroke related to large artery atherosclerosis (LAA). The PWV ratio was higher in LAA compared with non-LAA stroke [1.26 (1.09-1.58) vs. 1.10 (0.95-1.36), p < 0.01], remaining significant after adjustment (OR = 3.40, 95%CI = 1.18-9.79, p = 0.02). PWV ratio was not associated with MBP (p = 0.79). PWV ratio is elevated in LAA-related ischemic stroke and was not significantly associated with BP, supporting its potential role as a vascular risk marker.