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Updated: Jun 19, 2026
A Murine Model of Ischemic Retinal Injury Induced by Transient Bilateral Common Carotid Artery Occlusion
Published on: November 12, 2020
Retinal vascular caliber and extracranial carotid disease in patients with acute ischemic stroke: the Multi-Centre
Deidre A De Silva1, Gerald Liew, Meng-Cheong Wong
1Singapore General Hospital Campus, National Neuroscience Institute, Singapore. gnrdsd@sgh.com.sg
Insights
Wider retinal venules, a sign of microvascular disease, were strongly linked to severe carotid artery disease in stroke patients. This suggests microvascular changes may contribute to stroke risk from carotid disease.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Retinal vascular caliber and carotid disease are known stroke predictors.
- The relationship between these microvascular and macrovascular factors is not well understood.
Purpose of the Study:
- To investigate the association between retinal vascular caliber and carotid disease in patients with acute ischemic stroke.
Main Methods:
- Cross-sectional study of 1029 acute ischemic stroke patients from three centers.
- Retinal arteriole and venule caliber measured from digital retinal photographs.
- Severe extracranial carotid disease defined as stenosis >=75% or occlusion.
Main Results:
- Severe carotid disease found in 7% of patients.
- Wider retinal venular caliber significantly associated with ipsilateral severe carotid disease (OR, 3.81).
- Association remained significant in large artery stroke patients.
Conclusions:
- Retinal venular widening is strongly linked to severe ipsilateral carotid disease in stroke patients.
- Suggests co-existing retinal and cerebral microvascular disease in carotid disease patients.
- Microvascular disease may partially mediate stroke pathogenesis in carotid disease.
Background And Purpose:
Previous studies show that both retinal vascular caliber and carotid disease predict incident stroke in the general population, but the exact relationship between these 2 microvascular and macrovascular structural risk factors is unclear. We studied the relationship between retinal vascular caliber and carotid disease in patients presenting with acute ischemic stroke.
Methods:
We conducted a cross-sectional study of patients with acute ischemic stroke recruited from 3 centers (Melbourne, Sydney, Singapore). The caliber of retinal arterioles and venules was measured from digital retinal photographs. Severe extracranial carotid disease was defined as stenosis >or=75% or occlusion determined by carotid Doppler using North American Symptomatic Carotid Endarterectomy Trial-based criteria.
Results:
Among the 1029 patients with acute stroke studied, 7% of the population had severe extracranial carotid disease. Retinal venular caliber was associated with ipsilateral severe carotid disease (P<0.001 in multivariate models). Patients with wider retinal venular caliber were more likely to have severe ipsilateral carotid disease (multivariable-adjusted OR, 3.81; 95% CI, 1.80 to 8.07, comparing the largest and smallest venular caliber quartiles). The retinal venular caliber-carotid disease association remained significant in patients with large artery stroke.
Conclusions:
In patients with acute stroke, retinal venular widening was strongly associated with ipsilateral severe extracranial carotid disease. Our findings suggest concomitant retinal and cerebral microvascular disease may be present in patients with carotid stenosis or occlusion disease. The pathogenesis of stroke due to carotid disease may thus be partially mediated by microvascular disease.
