Determining risk of stroke in patients with ocular arterial occlusive disorders

Session Details

Session Title: Free Paper Session 11: Vascular Diseases & Diabetic Retinopathy III

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 11:36

Venue: Room 114

First Author: : I.Magal CANADA

Co Author(s): :    A. Kherani   M. Avery   A. Mitha                       

Abstract Details

Purpose:

To demonstrate the risk of stroke and death after ocular arterial event is higher then currently reported in the literature

Setting:

To calculate the risk for stroke and death after ocular arterial event: branch retinal artery occlusion (BRAO); central retinal artery occlusion (CRAO); ocular ischaemic syndrome (OIS)

Methods:

Data from all newly diagnosed BRAO, CRAO, and OIS patients between October 2008 and September 2013 in our facility were retrospectively assessed for three years. We checked for stroke events and deaths within that period of time as well as for stroke rate prior to the occlusive event and for death rate up to five years after the event. Risk rate is solely based on occurrence of stroke or death during the follow up period. We also evaluated imaging of carotid arteries and calculated rate of morbidity and mortality according to severity of findings.

Results:

84 patients (out of 75500) were included. 32 with BRAO; 30 with CRAO and 22 with OIS. All results are for BRAO, CRAO and OIS, respectively. Stroke rate prior to ocular event: 12.5%; 30.0%; 45.5%. New stroke risk (within 3 years): 14.3%; 9.5%; 33.3%. Overall stroke risk (pre+post): 25.0%; 36.7%; 63.6%. Death risk (within 3years): 9.4%; 6.7%; 31.8%. Overall stroke (pre+post) and death risk: 34.4%; 40.0%; 72.8%. Of the 84 patients, 81.3%; 93.3%; 81.8% of the patients had carotid imaging. The rate of new stroke in significant carotid stenosis (>50%) was 20% in BRAO, 12.5% in CRAO and 26.7% in OIS; while the rate was much less when the carotid findings were non-significant (≤50% stenosis) specifically 5% in BRAO and CRAO and 0% in OIS. Surprisingly, for the patients who did not have carotid imaging, the rates of death within 5 years were 83.3%; 50%; 75% in BRAO, CRAO and OIS respectively.

Conclusions:

The results suggest that patients with ocular arterial occlusive event are at high risk for both stroke and death. Carotid imaging findings can help determine the higher risk group (>50% stenosis) for new stroke and death. Those patients who did not further carotid imaging studies seemed to have an unusually high risk profile. Careful and organized medical evaluation, treatment and follow-up of these patients needs to be prioritized to prevent treatable stroke related morbidity and mortality

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