Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion
Patrick Lavin1, Morgan Patrylo2, Matthew Hollar3
1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Central retinal artery occlusion (CRAO) patients often have undiagnosed, modifiable risk factors. A systematic evaluation similar to stroke protocols reveals significant cardiovascular and cerebrovascular risks, necessitating prompt intervention.
Area of Science:
- Ophthalmology
- Neurology
- Cardiology
Background:
- Central retinal artery occlusion (CRAO) shares mechanistic similarities with stroke.
- Current stroke guidelines advocate for systematic risk factor evaluation.
- The diagnostic yield of stroke risk factor evaluation in CRAO patients is not well-established.
Purpose of the Study:
- To evaluate the diagnostic yield of a standardized cerebrovascular risk factor assessment in patients presenting with acute CRAO.
- To determine the frequency of stroke and other cardiovascular/cerebrovascular events in this population.
Main Methods:
- A cohort study of 103 patients with acute CRAO (2009-2017) at an academic hospital.
- Inclusion of vital signs, laboratory parameters (e.g., LDL, HbA1c), echocardiography, cardiac telemetry, MRI, and cerebrovascular imaging.
- Documentation of new diagnoses, treatments, and 24-month outcomes including stroke, myocardial infarction, and death.
Main Results:
- 36.7% had critical carotid disease, 37.3% had coincident acute stroke, and 33.0% presented with hypertensive emergency.
- 20.0% had myocardial infarction or critical cardiac disease; 25% required urgent surgical intervention.
- 93% experienced a medication change, and patients faced risks similar to high-risk transient ischemic attack (TIA).
Conclusions:
- Patients with CRAO exhibit a significant risk of future cardiovascular and cerebrovascular events.
- Systematic evaluation frequently identifies undiagnosed and modifiable risk factors.
- Prompt intervention based on comprehensive risk assessment is crucial for managing CRAO patients.
Purpose:
Central retinal artery occlusion (CRAO) is mechanistically similar to a stroke. Current guidelines recommend a standardized and systematic evaluation of risk factors for patients who have had a stroke. This study evaluates the yield of this evaluation in patients with CRAO and frequency of stroke in this population.
Design:
Cohort study.
Methods:
We evaluated the diagnostic yield of an expedited inpatient evaluation of cerebrovascular risk factors in a cohort of patients presenting with an acute CRAO within the period from 2009 to 2017 at an academic hospital. Vital signs and laboratory parameters, including low-density lipoprotein level, hemoglobin A1c fraction, erythrocyte sedimentation rate, C-reactive protein level, platelet count, and troponin level, were collected. Echocardiography, cardiac telemetry, magnetic resonance imaging (MRI), and cerebrovascular imaging were obtained to screen for strokes and vascular risk factors. All new diagnoses and clinical treatments stemming from the inpatient evaluation were documented. Outcomes included the frequency of stroke on MRI, hypertensive emergency, critical carotid disease, or critical cardiac disease, including high-grade valvular lesions, new myocardial infarction, or arrhythmias. We documented the frequency of a change in medication, acute surgical intervention, or new diagnosis of systemic disease as a result of the inpatient evaluation. Finally, we evaluated the rate of symptomatic stroke, myocardial infarct, and death risk in the 24 months after CRAO.
Results:
In this cohort of 103 patients with CRAO and systematic risk factor screening, 36.7% of patients had critical carotid disease, 37.3% had coincident acute stroke, 33.0% presented with hypertensive emergency, 20.0% had a myocardial infarction or critical structural cardiac disease, 25% underwent an urgent surgical intervention, and 93% had a change in medication as a result of the inpatient evaluation. Patients with CRAO had similar risk of subsequent stroke, myocardial infarction, and death as patients with high-risk transient ischemic attack.
Conclusions:
Patients with CRAO are at significant risk of future cardiovascular and cerebrovascular events and often have undiagnosed risk factors that may be modifiable.
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