Background: Peripheral arterial disease (PAD) in stroke patients indicates higher atherosclerotic burden and risk of recurrent cardiovascular events. Outcomes in acute stroke patients with PAD and the value of screening for PAD in stroke patients are not well known.Methods: Hospitalized patients with acute ischemic stroke were screened by measuring the ankle-brachial index (ABI) prospectively. Clinical characteristics, medical histories, cardiovascular risk factors, and the NIH Stroke Scale (NIHSS) were recorded. The Modified Rankin Scale and all clinic al events (including recurrent stroke, myocardial infarction, and death) were recorded at 1 month, 6 months, and at study end.Results: A total of 158 patients were recruited. Forty-one patients (25.9%) had an ABI < 0.9. Patients with an ABI < 0.9 were older, and had a higher prevalence of previous ischemic heart disease, fewer lacunar infarcts, a lower body mass index, and higher plasma concentrations of fibrinogen and C-reactive protein. The Kaplan-Meier event curve showed a higher clinical event rate (log rank p = 0.009) in patients with an ABI < 0.9 (36.6%) compared with that of patients with an ASI ~ 0.9 (17.9%) during a mean follow-up of 382 days (range: 266-4 85 days). Multivariate regression analysis showed that ABI < 0.9 (p = 0.020, OR: 2.204, 1.131-4 .293) and admission NIH stroke scale (p = 0.027, OR: 2.285, 1.098-4.758) were independent predictors for future clinical event s.Conclusion: Patients with acute ischemic stroke and a low ABI had poorer stroke out come and a higher rate of cardiovascular events and death. Screening for ABI in acute stroke patients may help to identify patients at high risk of future events.