Cerebral Small Vessel Disease in Branch Retinal Artery Occlusion

Cho, Kwan Hyuk; Kim, Chi Kyung; Woo, Se Joon; Park, Kyu Hyung; Park, Sang Jun

doi:10.1167/iovs.16-20106

Cited by 24 publications

(16 citation statements)

References 28 publications

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“…As in other studies, arterial hypertension was the most frequently identified risk factor, found in 84.7% of RAO patients [ 4 , 6 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 70%

“…The characteristic risk factors for CRAO and BRAO are nearly identical to those for ischemic stroke, with hypertension being the most common risk factor for both CRAO and BRAO [ 1 , 2 , 3 , 4 , 6 , 10 , 11 , 12 , 13 , 14 , 15 ]. Similar to patients with stroke, patients with RAO are at high risk of subsequent cardiovascular events [ 6 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Central and Branch Retinal Artery Occlusion—Do They Harbor the Same Risk of Further Ischemic Events?

Roskal-Wałek

Wałek

Biskup³

et al. 2021

JCM

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Purpose: Retinal artery occlusion (RAO) is associated with an increased risk of cardiovascular events such as ischemic stroke and myocardial infarction, but whether different RAO subtypes such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) carry similar risk of these events is unclear. Our aim was to determine whether the risk of cardiovascular events differs between CRAO and BRAO. Methods: This single-center, retrospective study included 131 patients hospitalized in our clinic in 2010–2020 with CRAO or BRAO confirmed by ophthalmic examination. Data on demographics, previous ischemic stroke and myocardial infarction, comorbidities, the results of echocardiographic and ultrasound carotid artery examinations and laboratory tests were assessed. Data on ischemic stroke, myocardial infarction, and all-cause mortality occurring after RAO were obtained from the Polish National Health Service, which collects data on all publicly funded hospitalizations. Using these data, Kaplan-Meier analyses and Cox proportional hazard regression were performed. Results: Ischemic stroke occurred in 9.9% of patients after RAO: 10.6% in the CRAO group and 8.1% in the BRAO group (p = 0.662). Myocardial infarction occurred in 2.3% of patients after RAO: 2.1% in the CRAO group and 2.7% in the BRAO group (p = 0.843). All-cause mortality occurred in 22.9% of patients after RAO: 25.5% in the CRAO group and 16.2% in the BRAO group (p = 0.253). The composite endpoint of ischemic stroke, myocardial infarction, and all-cause mortality after RAO occurred in 28.2% of patients: 30.9% in the CRAO group and 21.6% in the BRAO group (p = 0.338). There was no difference between CRAO and BRAO in median time to ischemic stroke (32 vs. 76.4 months; p = 0.352), all-cause mortality (35.9 vs. 36.3 months; p = 0.876) or composite endpoint (37.5 vs. 41.5 months; p = 0.912) after RAO. The Kaplan-Meier analysis showed no differences between CRAO and BRAO in ischemic stroke, myocardial infarction, all-cause mortality, or the composite endpoint; similar results were obtained in analyses of patients with and without cardiovascular events before RAO. Conclusions: The prognosis for ischemic stroke, myocardial infarction, and all-cause mortality is similar in patients with CRAO and BRAO. Ischemic strokes occur with a similar frequency before and after RAO. Myocardial infarctions are observed significantly more frequently before an episode of RAO than after. The results of our study indicate that both CRAO and BRAO require expanded diagnostics to assess the risk of recurrent cardiovascular events, especially ischemic strokes, to implement appropriate prophylaxis and reduce mortality.

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“…As in other studies, arterial hypertension was the most frequently identified risk factor, found in 84.7% of RAO patients [ 4 , 6 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Central and Branch Retinal Artery Occlusion—Do They Harbor the Same Risk of Further Ischemic Events?

Roskal-Wałek

Wałek

Biskup³

et al. 2021

JCM

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“…Detailed descriptions of the MRI protocols and SVD findings on the brain MRIs were published in our previous studies. [11, 12] Briefly, MRI protocols included T1-weighted, T2-weighted, T2* gradient-recalled echo (GRE), diffusion-weighted, and fluid-attenuated inversion recovery (FLAIR) images. WMH were defined as areas of bright, high-signal intensities noted on T2-weighted images and graded by Fazekas score.…”

Section: Methodsmentioning

confidence: 99%

Nonarteritic anterior ischemic optic neuropathy is associated with cerebral small vessel disease

et al. 2019

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We investigated the presence of cerebral small vessel disease (SVD) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) compared to control subjects without NAION to identify the association between NAION and cerebral SVD. We retrospectively reviewed the cases of 63 patients with NAION and 2749 control subjects without any neurologic and ocular diseases including NAION who underwent careful medical interviews, ophthalmic examinations, and magnetic resonance imaging (MRI) studies of the brain. We assessed and compared the degree of cerebral SVD on the MRIs. The patients with NAION presented with cerebral SVD more frequently than controls (68% versus 37%, respectively, p<0.001), which was also observed after adjusting for age, sex, comorbid conditions including hypertension, diabetes, and dyslipidemia, and smoking using the standardized mortality ratio (68% vs. 37%, p<0.001). A multivariate logistic regression analysis showed that the odds of cerebral SVD were 4.86 (95% CI, 2.10 to 11.24, p<0.001) times higher in patients with NAION than in the controls. We found that there was an association between cerebral SVD and NAION even after adjusting for age, sex, and medical histories. Clinicians should consider brain MRI scans in patients with NAION to prevent neurological impairment after cerebral SVD.

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“…Another earlier finding suggested that WMHs are associated with HIV seropositive individuals [ 160 ]. Recently, during investigation of the BRAO, it was suggested that small vessel etiology may play a pivotal role in pathophysiology of BRAO [ 161 ]. The above investigations give another dimension of cSVD research and exploration in the direction of linkage to several other non-cerebral disorders.…”

Section: Cerebral Small Vessel Disease Associated Diseasesmentioning

confidence: 99%

Cerebral Small Vessel Disease: A Review Focusing on Pathophysiology, Biomarkers, and Machine Learning Strategies

Cuadrado-Godia

Dwivedi

Sharma³

et al. 2018

J Stroke

226

157

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Cerebral small vessel disease (cSVD) has a crucial role in lacunar stroke and brain hemorrhages and is a leading cause of cognitive decline and functional loss in elderly patients. Based on underlying pathophysiology, cSVD can be subdivided into amyloidal and non-amyloidal subtypes. Genetic factors of cSVD play a pivotal role in terms of unraveling molecular mechanism. An important pathophysiological mechanism of cSVD is blood-brain barrier leakage and endothelium dysfunction which gives a clue in identification of the disease through circulating biological markers. Detection of cSVD is routinely carried out by key neuroimaging markers including white matter hyperintensities, lacunes, small subcortical infarcts, perivascular spaces, cerebral microbleeds, and brain atrophy. Application of neural networking, machine learning and deep learning in image processing have increased significantly for correct severity of cSVD. A linkage between cSVD and other neurological disorder, such as Alzheimer’s and Parkinson’s disease and non-cerebral disease, has also been investigated recently. This review draws a broad picture of cSVD, aiming to inculcate new insights into its pathogenesis and biomarkers. It also focuses on the role of deep machine strategies and other dimensions of cSVD by linking it with several cerebral and non-cerebral diseases as well as recent advances in the field to achieve sensitive detection, effective prevention and disease management.

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Cerebral Small Vessel Disease in Branch Retinal Artery Occlusion

Abstract: Patients with BRAO showed different cerebrovascular characteristics following retinal emboli, including brain MRI findings. The results suggest that we must consider SVD etiology as well as large vessel disease mechanisms in the pathophysiology of BRAO.

Cited by 24 publications

References 28 publications

Central and Branch Retinal Artery Occlusion—Do They Harbor the Same Risk of Further Ischemic Events?

Central and Branch Retinal Artery Occlusion—Do They Harbor the Same Risk of Further Ischemic Events?

Nonarteritic anterior ischemic optic neuropathy is associated with cerebral small vessel disease

Cerebral Small Vessel Disease: A Review Focusing on Pathophysiology, Biomarkers, and Machine Learning Strategies

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