Risk of Stroke in Patients With Ocular Arterial Occlusive Disorders: A Retrospective Canadian Study
Risk of Stroke in Patients With Ocular Arterial Occlusive Disorders: A Retrospective Canadian Study
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眼动脉闭塞性疾病患者的卒中风险：一项加拿大回顾性研究
DOI：
10.1161/jaha.118.010509
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发表时间：
2019-02-05
影响因子：
5.4
通讯作者：
Mitha, Alim P.
中科院分区：
文献类型：
--
作者：
Avery, Michael B.;Magal, Itay;Mitha, Alim P.
单眼视力丧失，归因于视网膜中央动脉阻塞（CRAO）、视网膜分支动脉阻塞（BRAO）或眼缺血综合征（OIS），被认为与脑梗死的发病率增加有关。然而，证明这一点的数据很少。我们的目的是调查这种关系，在加拿大的中心，并进一步了解相关的颈内动脉狭窄的重要性，在潜在的临床decisionmaking.Methods和Results-We进行了一项回顾性队列研究，在一个全面的中风中心的患者最初提出与CRAO，BRAO，或OIS的中央眼科中心超过5年的时间。对患者进行了3年的半球卒中随访。我们确定了83只受影响的眼睛，其中31例CRAO，35例BRAO和17例OIS患者。在眼部诊断之前，分别有32.3%、11.4%和41.2%的CRAO、BRAO和OIS患者发生了症状性卒中。其余患者中，分别有4.8%、12.9%和40%在眼科诊断后3年内发生半球卒中。Logistic回归分析表明，对于CRAO和BRAO患者一起，同侧颈内动脉狭窄的程度是无法预测中风的发生（P=0.18），而我们的模型正确预测中风在82.4%的OIS patients（P=0.005）。同侧颈内动脉狭窄程度可能对这些患者的风险分层没有帮助，这表明他们应该被适当地分类用于卒中风险因素管理，而不依赖于颈内动脉狭窄。
Background-Monocular vision loss, attributed to either central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), or ocular ischemic syndrome (OIS), is thought to be associated with an increased prevalence of cerebral infarcts. However, there is a paucity of data substantiating this. We aimed to investigate this relationship in a Canadian center and further understand the importance of associated internal carotid artery stenosis in potential clinical decision making.Methods and Results-We performed a retrospective cohort study at a comprehensive stroke center of patients presenting initially with CRAO, BRAO, or OIS to a centralized ophthalmology center over a 5-year period. Patients were followed for 3 years for the occurrence of a hemispheric stroke. We identified 83 affected eyes, with 31 CRAO, 35 BRAO, and 17 OIS patients. Before ocular diagnosis, 32.3%, 11.4%, and 41.2% of CRAO, BRAO, and OIS patients, respectively, experienced a symptomatic stroke. Of the remaining patients, 4.8%, 12.9%, and 40%, respectively, suffered a hemispheric stroke within 3 years of ocular diagnosis. Logistic regressions suggested that for CRAO and BRAO patients together, the degree of ipsilateral internal carotid artery stenosis is unable to predict the occurrence of a stroke (P=0.18), whereas our model correctly predicted a stroke in 82.4% of OIS patients (P=0.005).Conclusions-CRAO, BRAO, and OIS are associated with significantly increased symptomatic stroke rates. Degree of ipsilateral internal carotid artery stenosis may not be useful in risk stratification for these patients, suggesting that they should be triaged appropriately for stroke risk-factor management, independent of internal carotid artery stenosis.