Retinal microvascular changes and subsequent vascular events after ischemic stroke

Silva, Deidre Anne De; Manzano, J J; Liu, E. Y.; Woon, Fung Peng; Wong, W.; Chang, Hui Meng; Chen, C.; Lindley, Richard I.; Wang, J. J.; Mitchell, Paul; Wong, Tien Yin; Wong, Meng Cheong

doi:10.1212/wnl.0b013e31822c623b

Cited by 53 publications

(34 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, alterations in conjunctival blood flow due to ICA occlusion have also been reported (Pavlou and Wolff, 1959). Recently, several studies have demonstrated retinal microvascular changes to be associated with, or predictive of stroke (De Silva et al, 2011; Doubal et al, 2009; Ikram et al, 2006; McGeechan et al, 2009; Ong et al, 2013; Wang et al, 2007; Wieberdink et al, 2010; Wong et al, 2001). Since the retina and conjunctiva have a common source of blood from the ophthalmic artery and analogous alterations in the retinal and conjunctival microvasculature have been reported in hypertension and diabetes (To et al, 2013; To et al, 2011), it is likely that the conjunctival microcirculation is also affected by stroke.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of assessment of conjunctival microvascular hemodynamics in unilateral ischemic stroke

Valeshabad

Wanek

Mukarram

et al. 2015

Microvascular Research

View full text Add to dashboard Cite

Since the internal carotid artery supplies blood to both the eye and the brain, ocular microvascular hemodynamics can be altered due to ischemic stroke. The purpose of the current study was to establish the feasibility of conjunctival microcirculation imaging for detection of inter-ocular differences in microvascular hemodynamics in subjects with unilateral ischemic stroke. Conjunctival microcirculation imaging was performed in both eyes of 15 healthy control subjects and 12 subjects following unilateral ischemic stroke. Diameter and axial blood velocity were measured in multiple conjunctival venules of each eye. A two-way repeated measures analysis of variance was performed to determine the effects of stroke (control vs. stroke) and side of stroke (ipsilateral vs. contralateral) on conjunctival diameter and axial blood velocity. There was not a significant main effect of stroke on conjunctival diameter (P = 0.7) or conjunctival axial blood velocity (P = 0.9). There was not a significant main effect of side of stroke on conjunctival diameter (P = 0.8), but there was a significant main effect of side of stroke on conjunctival axial blood velocity (P = 0.02). There was a significant interaction effect between stroke and side of stroke (P = 0.04), indicating conjunctival axial blood velocity was lower in ipsilateral eyes than in contralateral eyes of stroke subjects. Conjunctival axial blood velocity and internal carotid artery blood velocity were correlated in stroke subjects (r = 0.75, P = 0.01, N = 10). Conjunctival microcirculation imaging is a feasible method to detect inter-ocular differences in microvascular hemodynamics in subjects with unilateral ischemic stroke.

show abstract

Section: Introductionmentioning

confidence: 99%

Feasibility of assessment of conjunctival microvascular hemodynamics in unilateral ischemic stroke

Valeshabad

Wanek

Mukarram

et al. 2015

Microvascular Research

View full text Add to dashboard Cite

show abstract

“…Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure. [10][11][12][13][14][15][16] Thus, it is not surprising that renal microvascular pathology has been considered an important factor in CKD progression. 17 One pathophysiological aspect of the microcirculation is vascular remodeling in small arteries, including microvascular narrowing.…”

mentioning

confidence: 99%

Microcirculatory Marker for the Prediction of Renal End Points

2014

View full text Add to dashboard Cite

T he prevalence of chronic kidney disease (CKD) has increased during the past years worldwide, 1 imposing a major burden on health-care systems. It is important to prevent CKD, thereby to reduce the need for renal replacement therapy and the rising morbidity and mortality associated with end-stage renal disease.2 Therefore, an efficient individual prediction of CKD progression is warranted.Several factors are involved in CKD progression, including baseline renal function, age, ethnicity, diabetes mellitus, blood pressure, use of renin-angiotensin system (RAS) blocker, and albuminuria.3-9 Despite these single predictive factors, an individual prediction of CKD progression remains difficult. Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure.10-16 Thus, it is not surprising that renal microvascular pathology has been considered an important factor in CKD progression. 17 One pathophysiological aspect of the microcirculation is vascular remodeling in small arteries, including microvascular narrowing. 18,19 The latter can be assessed by noninvasive retinal vessel analysis.20,21 Narrow retinal arterioles are associated with age, black race, hypertension, and albuminuria. Ooi et al 22 and our group described narrow retinal arteries in patients with advanced CKD. 23,24 Similar to systemic arteriolar narrowing, the retinal and preglomerular arterioles could show the same effects.25 Narrow preglomerular arterioles increase intraglomerular pressure and contribute to the glomerular defect, determined by albuminuria, as has been demonstrated in spontaneously hypertensive rats and in patients with diabetes mellitus. [25][26][27][28] We hypothesize that retinal arteriolar narrowing predicts CKD progression and subsequently renal end points. Moreover and of importance to clinical practice, we hypothesize that Abstract-Retinal arteriolar narrowing reflects aging, hypertension, chronic kidney disease (CKD), and other vascular processes. We examined the predictive value of retinal arteriolar narrowing alone and in combination with albuminuria on renal disease progression in CKD. A white CKD stage 2 to 4 cohort of 164 men and women (60.8±13.8 years) underwent retinal photography and determination of albuminuria. The calibers of all retinal arterioles were measured after digital conversion of the photographs. Cases of incident renal end points defined as 50% renal function loss and start of renal replacement therapy were identified and validated by case record reviews. Over an average period of 1410 (range, 106-1606) days, 25 patients with CKD had incident renal end points. Kaplan-Meier analysis revealed that patients with CKD within the tertile of narrowest arterioles had more renal end points (log-rank P<0.001). Cox regression analysis confirmed this before (β=1.183±0.411) and after adjusting for age and baseline renal function (β=1.204±0.416). With respect to renal end points, a significant interaction was present between narrow arterioles and a...

show abstract

“…Retina offers a unique window to the study of cerebral micro vascular lesion, because of its accessibility and non-invasiveness through fundoscopy. Several studies [18][19][20] report that retinal micro vascular changes such as arteriolar narrowing, arteriovenous nicking, micro aneurysms, micro exudates and micro hemorrhages are strongly associated with subclinical [21][22][23][24] and clinical cerebrovascular damage. Agreeing with those reports, we found in our patient, several lesions, indicating an important degree of retinal small vessels injury associated with important silent cerebrovascular injuries observed on MRI.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Electroencephalographic Changes and Retinal Alterations in Subclinical Cerebrovascular Injury: A Case Report

Brown-Martínez¹

2017

Austin J Cerebrovasc Dis & Stroke

View full text Add to dashboard Cite

Small vessel disease induced by arterial hypertension is associated with an increased risk of stroke, dementia, cognitive impairment, and death. It comprises a group of lesions visible only by magnetic resonance imaging technique, which cannot be used in a comprehensive evaluation of hypertensive patient because of its cost and availability. We present an uncontrolled hypertensive patient with cardiovascular risk factors, with no history of previous cerebro vascular events presenting signs of small vessel disease on brain resonance imaging. Evident signs of hypertensive retinopathy in both eyes were observed, with micro hemorrhage and micro exudates in the left eye. Quantitative electroencephalographic analysis showed a significant increase in theta frequency, predominantly in left frontal, central and temporal regions. These findings could indicate the potential of these simpler and economical methods, in the prediction of subclinical brain damage of hypertensive patients.

show abstract

Retinal microvascular changes and subsequent vascular events after ischemic stroke

Cited by 53 publications

References 32 publications

Feasibility of assessment of conjunctival microvascular hemodynamics in unilateral ischemic stroke

Feasibility of assessment of conjunctival microvascular hemodynamics in unilateral ischemic stroke

Microcirculatory Marker for the Prediction of Renal End Points

Quantitative Electroencephalographic Changes and Retinal Alterations in Subclinical Cerebrovascular Injury: A Case Report

Contact Info

Product

Resources

About