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The clinical significance of the asymptomatic Hollenhorst plaque
Insights
Hollenhorst plaques, often found in asymptomatic patients, have a low correlation with surgically remediable carotid bifurcation disease. Amaurosis fugax, however, indicates a higher likelihood of significant cerebrovascular disease.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Surgery
Background:
- Cerebrovascular insufficiency can manifest as visual complaints.
- Hollenhorst plaques are embolic events in retinal arteries.
- The association between asymptomatic Hollenhorst plaques and carotid artery disease requires clarification.
Purpose of the Study:
- To evaluate the correlation between Hollenhorst plaques, amaurosis fugax, and fixed visual deficits with carotid bifurcation disease.
- To determine the predictive value of Hollenhorst plaques for future embolic events.
- To assess the need for surgical intervention in patients with these conditions.
Main Methods:
- Sixty patients with visual complaints underwent complete cerebral angiography (CCA).
- Patients were categorized based on asymptomatic Hollenhorst plaques, amaurosis fugax, or fixed visual deficits.
- Ocular fundus photography was used for serial evaluation of Hollenhorst plaques.
Main Results:
- Asymptomatic Hollenhorst plaques were associated with carotid bifurcation disease in 50% of cases, but only 16% were surgically remediable.
- Amaurosis fugax patients showed a 70% incidence of significant bifurcation disease, with 50% requiring carotid endarterectomy (CEA).
- Patients with fixed visual deficits had a 100% incidence of bifurcation disease and 85% had intracranial disease, with only one amenable to surgery.
Conclusions:
- Hollenhorst plaque as an isolated finding has poor predictive power for further embolic events and low correlation with significant or surgically amenable carotid bifurcation disease.
- Amaurosis fugax is a stronger indicator of significant cerebrovascular disease requiring intervention.
- Fixed visual deficits indicate extensive cerebrovascular disease, often with intracranial involvement and limited surgical options.
Abstract:
Sixty consecutive patients with visual complaints as the primary symptom of cerebrovascular insufficiency were evaluated with complete cerebral angiography (CCA). Eighteen patients referred for evaluation of asymptomatic Hollenhorst plaques had a 50% incidence of ipsilateral carotid bifurcation disease, but only 16% of these were considered surgically remediable; five of these patients eventually required carotid endarterectomy (CEA). Nine of the 18 patients with asymptomatic Hollenhorst plaques were further evaluated with serial ocular fundus photography: the plaque persisted in all nine patients--in four for more than 6 months and in five for more than 1 year. No patient had transient or fixed retinal or cerebral symptoms. Twenty-six patients with amaurosis fugax showed a 70% incidence of significant bifurcation disease and three had significant intracranial disease; 50% eventually required CEA. Twelve patients with fixed visual deficits (four patients had homonymous hemianopsia, four had retinal artery occlusions, and four had ischemic retinopathies) demonstrated a 100% incidence of bifurcation disease, but in addition 85% had significant intracranial disease; only one of this group had surgically amenable disease. Amaurosis fugax preceded blindness in two patients. Hollenhorst plaque as an isolated phenomenon appears to be a retinal embolic event of uncertain age, with poor predictive power for further embolic events, and not as highly correlated with significant or surgically amenabe carotid bifurcation disease.