Stroke Risk Before and After Central Retinal Artery Occlusion in a US Cohort

Central retinal artery occlusion as a neuro‐ophthalmological emergency: the need to raise public awareness

“…CRAO not only shares typical risk factors and underlying aetiology with cerebral ischaemia, but it can also herald or complicate acute ischaemic stroke 10,11 and it may be the sole clinical manifestation of cerebrovascular disease in patients with silent cerebral diffusion‐weighted imaging lesions 8,12,13 . Since silent cerebral infarctions are strong predictors of future risk for stroke, 14 the evaluation of CRAO patients should include MRI of the brain in addition to cardial, carotid artery and metabolic assessments, as well as the search for hypercoagulable states and signs of vasculitis 5 .…”

Retinal artery occlusion and risk of stroke

“…Magnetic resonance imaging performed in 36.7% of patients demonstrated silent ischemic stroke in 10%. 5 The authors concluded that their study confirmed the evidence of increased risk of ischemic stroke in patients diagnosed with CRAO. 5 Therefore, these data suggest that actually the risk of ischemic stroke in patients diagnosed with acute RAO is high and there is the need for urgent referral to a stroke unit or emergency department for a cardiovascular workup and neuroimaging evaluation.…”

“…We recently conducted a systematic review and meta-analysis of the risk of stroke after RAO; 30% of acute CRAOs and 25% of acute branch RAOs had acute cerebral ischemia on magnetic resonance imaging, which may be asymptomatic. 4 In addition, Chodnicki et al 5 recently conducted a single-center (Mayo Clinic) retrospective study with a similar design to the one of Laczynski et al 1 They included 300 CRAO patients and found that 5.3% had a symptomatic ischemic stroke in the peri-CRAO period, 2.3% within 15 days before diagnosis of CRAO and 3% simultaneously with or 15 days after the event. Magnetic resonance imaging performed in 36.7% of patients demonstrated silent ischemic stroke in 10%.…”

Carotid endarterectomy for asymptomatic carotid stenosis has a higher risk of morbidity and mortality in octogenarians

“…The Mayo Clinic experience found a 3% rate of stroke simultaneous with or 15 days after the RAO event, well within our confidence limits. 4 It is important to note a few further details from this study. First, 7 of 16 strokes occurred in the setting of >70% ipsilateral carotid stenosis.…”

“…2,3 With modern medical therapy, the overall risk of stroke in asymptomatic patients is quite low, with some advocating that these patients, regardless of age, do not benefit from prophylactic endarterectomy. 4 Many of those with advanced age may be even less likely to derive any stroke-free or survival benefit.…”