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Risk of Stroke Recurrence Following Isolated Retinal Artery Occlusion Versus Minor Stroke or Transient Ischemic
Huanwen Chen1, Marco Colasurdo2, Julie Falardeau3
1Division of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.).
Stroke
|September 4, 2025
Summary
Isolated retinal artery occlusion (iRAO) poses a lower risk of subsequent cerebral infarction compared to nondisabling ischemic cerebrovascular events (NICEs). This suggests iRAO requires distinct secondary stroke prevention strategies.
Area of Science:
- Ophthalmology and Neurology
- Vascular Neurology
- Stroke Epidemiology
Background:
- Retinal artery occlusion (RAO) is classified as an ischemic stroke, but evidence guiding its management and prognosis is limited.
- The risk of recurrent stroke after isolated RAO (iRAO) without concurrent cerebral infarction is not well understood.
- Comparing iRAO to nondisabling ischemic cerebrovascular events (NICEs) is crucial for understanding stroke recurrence risk.
Purpose of the Study:
- To compare the risk of subsequent cerebral infarction in patients with nonarteritic iRAO versus NICE.
- To evaluate the prognostic implications of iRAO in the context of ischemic cerebrovascular events.
- To inform secondary stroke prevention strategies for iRAO patients.
Main Methods:
- Retrospective cohort study utilizing the 2016-2022 Nationwide Readmissions Database.
- Inclusion of adult patients hospitalized primarily for RAO or NICE, with exclusions for severe stroke, functional dependence, or concomitant cerebral infarction.
- Propensity score matching (2:1 ratio) to balance cohorts, followed by Cox regression analysis to determine the primary outcome (cerebral infarction within 300 days).
Main Results:
- After propensity score matching, 11,185 patients with nonarteritic iRAO and 22,757 patients with NICE were analyzed.
- Patients with iRAO demonstrated a significantly lower risk of subsequent cerebral infarction (Hazard Ratio: 0.26; P<0.001).
- Absolute cerebral infarction rates at 30, 90, and 180 days were substantially lower in the iRAO cohort compared to the NICE cohort.
Conclusions:
- Nonarteritic iRAO is associated with a significantly lower risk of subsequent cerebral infarction than NICE.
- iRAO events should not be considered equivalent to other ischemic cerebrovascular events regarding subsequent stroke risk.
- Further research is warranted to develop optimized secondary stroke prevention strategies specifically for nonarteritic iRAO.
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