Risk of Stroke in Patients With Ocular Arterial Occlusive Disorders: A Retrospective Canadian Study

• Published in: Journal of the American Heart Association Vol. 8; no. 3; p. e010509
• Main Authors: Avery, Michael B, Magal, Itay, Kherani, Amin, Mitha, Alim P
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 05-02-2019; Wiley
• Subjects: Aged; Aged, 80 and over; Branch retinal artery occlusion; Canada - epidemiology; Central retinal artery occlusion; cerebral infarct; Cerebral Infarction - diagnosis; Cerebral Infarction - epidemiology; Cerebral Infarction - etiology; Female; Follow-Up Studies; Humans; Incidence; Magnetic Resonance Imaging; Male; Middle Aged; Ocular ischemic syndrome; Original Research; Prevalence; Retinal Artery Occlusion - complications; Retinal Artery Occlusion - diagnosis; Retinal Artery Occlusion - epidemiology; retinal ischemia; Retrospective Studies; Risk Assessment - methods; stenosis; Survival Rate - trends; Time Factors; Tomography, X-Ray Computed; Ultrasonography, Doppler; Vision, Monocular - physiology; Canada; Central retinal artery occlusion; Ocular ischemic syndrome; retinal ischemia; cerebral infarct; stenosis; stroke; Branch retinal artery occlusion
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.118.010509

Background Monocular vision loss, attributed to either central retinal artery occlusion ( CRAO ), branch retinal artery occlusion ( BRAO ), or ocular ischemic syndrome ( OIS ), is thought to be associated with an increased prevalence of cerebral infarcts. However, there is a paucity of data substantiating this. We aimed to investigate this relationship in a Canadian center and further understand the importance of associated internal carotid artery stenosis in potential clinical decision making. Methods and Results We performed a retrospective cohort study at a comprehensive stroke center of patients presenting initially with CRAO , BRAO , or OIS to a centralized ophthalmology center over a 5-year period. Patients were followed for 3 years for the occurrence of a hemispheric stroke. We identified 83 affected eyes, with 31 CRAO , 35 BRAO , and 17 OIS patients. Before ocular diagnosis, 32.3%, 11.4%, and 41.2% of CRAO , BRAO , and OIS patients, respectively, experienced a symptomatic stroke. Of the remaining patients, 4.8%, 12.9%, and 40%, respectively, suffered a hemispheric stroke within 3 years of ocular diagnosis. Logistic regressions suggested that for CRAO and BRAO patients together, the degree of ipsilateral internal carotid artery stenosis is unable to predict the occurrence of a stroke ( P=0.18), whereas our model correctly predicted a stroke in 82.4% of OIS patients ( P=0.005). Conclusions CRAO , BRAO , and OIS are associated with significantly increased symptomatic stroke rates. Degree of ipsilateral internal carotid artery stenosis may not be useful in risk stratification for these patients, suggesting that they should be triaged appropriately for stroke risk-factor management, independent of internal carotid artery stenosis.