{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:19:56Z","timestamp":1781846396604,"version":"3.54.5"},"reference-count":31,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Beijing Municipal Natural Science Foundation","award":["7212049"],"award-info":[{"award-number":["7212049"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Concurrent atherosclerosis (AS) in peripheral arteries may worsen the prognosis of ischemic cerebrovascular disease (ICVD) patients. Although cervicocephalic atherosclerotic burden (AB) has demonstrated strong risk stratification capabilities, whether peripheral arterial evaluation provides incremental prognostic value remains unclear. This study aimed to determine whether cervicocephalic\u2013peripheral AB (CPAB) improves risk stratification in ICVD patients. Methods: This prospective cohort study consecutively included acute ICVD patients. AB scores for intracranial, cervical, renal, and lower extremity arteries were assigned as 0 (no stenosis), 1 (significant stenosis in one segment), or 2 (significant stenosis in \u22652 segments). The total score (range 0\u20138) was trisected into low, medium, and high CPAB levels. The primary endpoint was a composite of ischemic stroke, acute coronary syndrome, and vascular death. Model performance was evaluated using Harrell\u2019s C and Somers\u2019 D. Results: Among 403 patients (mean follow-up: 9.6 \u00b1 5.4 months), 41 primary endpoints occurred, and 21 (5.2%) were lost to follow-up. Of 382 patients analyzed, 30.6% had significant peripheral AS. Patients with concurrent peripheral-cervicocephalic AS had a higher risk of vascular events (p = 0.001) than those with single-territory AS. CPAB was independently associated with the primary endpoint (HR = 2.22, p &lt; 0.001) and stroke recurrence (HR = 1.90, p = 0.013). While cervicocephalic AB also independently predicted outcomes, the CPAB-based multivariate Cox model had improved discriminative performance (Harrell\u2019s C = 0.678 vs. 0.653 for primary endpoint, p = 0.02; 0.646 vs. 0.634 for stroke recurrence, p = 0.03). Conclusions: Peripheral AS is common in ICVD patients and contributes independently to vascular risk. The CPAB score, which integrates atherosclerotic burden from both cervicocephalic and peripheral territories, could improve prognostic stratification compared to single-territory or cervicocephalic AB alone, supporting comprehensive multiterritorial AS assessment to guide risk-based management strategies.<\/jats:p>","DOI":"10.3390\/jcm14186593","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:11:01Z","timestamp":1758269461000},"page":"6593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessment of Cervicocephalic\u2013Peripheral Atherosclerotic Burden Improves Prognostic Stratification in Patients with Ischemic Cerebrovascular Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8985-6750","authenticated-orcid":false,"given":"Lu-Guang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"},{"name":"National Clinical Research Center for Geriatric Disorders, Beijing 100053, China"},{"name":"The Neuro Cardio Vascular Diseases Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5135-291X","authenticated-orcid":false,"given":"Xin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"},{"name":"National Clinical Research Center for Geriatric Disorders, Beijing 100053, China"},{"name":"The Neuro Cardio Vascular Diseases Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8199-425X","authenticated-orcid":false,"given":"Xiaoxi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"},{"name":"National Clinical Research Center for Geriatric Disorders, Beijing 100053, China"},{"name":"The Neuro Cardio Vascular Diseases Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0995-2046","authenticated-orcid":false,"given":"Xiangying","family":"Du","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Geriatric Disorders, Beijing 100053, China"},{"name":"Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing 100053, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1055\/s-0038-1649503","article-title":"Global Burden of Stroke","volume":"38","author":"Katan","year":"2018","journal-title":"Semin. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.amjcard.2013.09.015","article-title":"Co-Existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral arterial disease in patients with coronary artery disease","volume":"113","author":"Imori","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11773","DOI":"10.1038\/s41598-024-62092-1","article-title":"Correlation and risk factors of peripheral and cervicocephalic arterial atherosclerosis in patients with ischemic cerebrovascular disease","volume":"14","author":"Li","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1177\/1358863X13493825","article-title":"Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: Insights from the Heart and Soul Study","volume":"18","author":"Grenon","year":"2013","journal-title":"Vasc. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.1093\/eurheartj\/ehp355","article-title":"Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry","volume":"30","author":"Alberts","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1253\/circj.71.1942","article-title":"Renal artery stenosis in cardio-and cerebrovascular disease: Renal duplex ultrasonography as an initial screening examination","volume":"71","author":"Kawarada","year":"2007","journal-title":"Circ. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.3109\/08037051.2013.765635","article-title":"Correlation of atherosclerotic renal artery stenosis with extracranial carotid and intracranial cerebral artery atherosclerosis in patients with ischemic stroke","volume":"22","author":"Wang","year":"2013","journal-title":"Blood Press."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1161\/HYPERTENSIONAHA.120.15036","article-title":"Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients with Ischemic Stroke","volume":"75","author":"Kong","year":"2020","journal-title":"Hypertension"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.5551\/jat.63226","article-title":"A Whole-Scope Evaluation of Cervicocephalic Atherosclerotic Burden is Essential to Predict 90-Day Functional Outcome in Large-Artery Atherosclerotic Stroke","volume":"29","author":"Yang","year":"2022","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e029505","DOI":"10.1161\/JAHA.123.029505","article-title":"Atherosclerosis Burden of Brain- and Heart-Supplying Arteries and the Relationship with Vascular Risk in Patients with Ischemic Stroke","volume":"12","author":"Kong","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4274\/ijca.2024.18291","article-title":"Impact of Atherosclerotic Burden on Long-term Major Adverse Cardiovascular and Cerebrovascular Events","volume":"10","author":"Esin","year":"2024","journal-title":"Int. J. Cardiovasc. Acad."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"792","DOI":"10.5551\/jat.47464","article-title":"Patients with Acute Ischemic Cerebrovascular Disease with Coronary Artery Stenosis Have More Diffused Cervicocephalic Atherosclerosis","volume":"26","author":"Kong","year":"2019","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12938-018-0494-4","article-title":"Peripheral vascular disease assessment in the lower limb: A review of current and emerging non-invasive diagnostic methods","volume":"17","author":"Gargiulo","year":"2018","journal-title":"Biomed. Eng. Online"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1161\/01.STR.31.1.61","article-title":"Prevalence of renal artery stenosis in autopsy patients with stroke","volume":"31","author":"Kuroda","year":"2000","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"Np1","DOI":"10.1177\/1358863X17701592","article-title":"2016 AHA\/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary","volume":"22","author":"Gornik","year":"2017","journal-title":"Vasc. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/HCO.0000000000000911","article-title":"Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management","volume":"36","author":"Dzaye","year":"2021","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jacc.2014.11.041","article-title":"The myth of the \u201cvulnerable plaque\u201d: Transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment","volume":"65","author":"Fuster","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s40001-023-01050-5","article-title":"Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease","volume":"28","author":"Li","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_22","first-page":"543","article-title":"Expert Consensus on Ultrasound Diagnosis of Renal Artery Stenosis","volume":"18","author":"Xu","year":"2021","journal-title":"Chin. J. Med. Ultrasound"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"iii-184","DOI":"10.3310\/hta11200","article-title":"A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease","volume":"11","author":"Collins","year":"2007","journal-title":"Health Technol. Assess."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1161\/CIR.0000000000001005","article-title":"Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement from the American Heart Association","volume":"144","author":"Criqui","year":"2021","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1161\/STROKEAHA.115.011321","article-title":"Ankle-Brachial Index and Recurrent Stroke Risk: Meta-Analysis","volume":"47","author":"Hong","year":"2016","journal-title":"Stroke"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.01.049","article-title":"Low Ankle-Brachial Index is a Simple Physical Exam Sign Predicting Intracranial Atherosclerotic Stenosis in Ischemic Stroke Patients","volume":"25","author":"Barros","year":"2016","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1161\/STROKEAHA.118.023534","article-title":"Stroke in Patients with Peripheral Artery Disease","volume":"50","author":"Kolls","year":"2019","journal-title":"Stroke"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1038\/s41569-021-00663-9","article-title":"Update on the pathophysiology and medical treatment of peripheral artery disease","volume":"19","author":"Golledge","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: The European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejphar.2015.03.090","article-title":"The renin-angiotensin system and its involvement in vascular disease","volume":"763","author":"Essers","year":"2015","journal-title":"Eur. J. Pharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1161\/ATVBAHA.112.249516","article-title":"Deletion of the angiotensin II type 1a receptor prevents atherosclerotic plaque rupture in apolipoprotein E-\/- mice","volume":"32","author":"Aono","year":"2012","journal-title":"Arterioscler. Thromb. Vasc. Biol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6593\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:40Z","timestamp":1760035720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":31,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186593"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186593","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}