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Ophthalmology Feb 2022To determine the risk of stroke, transient ischemic attack (TIA), and transient monocular vision loss (TMVL) before and after a central retinal artery occlusion (CRAO).
PURPOSE
To determine the risk of stroke, transient ischemic attack (TIA), and transient monocular vision loss (TMVL) before and after a central retinal artery occlusion (CRAO).
DESIGN
Population-based, retrospective case series.
PARTICIPANTS
Patients diagnosed with a CRAO in Olmsted County, Minnesota, from 1976 to 2016.
METHODS
Patients living in Olmsted County with a diagnosis code of CRAO from 1976 to 2016 were reviewed. New CRAOs were confirmed, and stroke, TIA, and TMVL events in the 15 days before and after CRAO were recorded.
MAIN OUTCOME MEASURES
Incidence of stroke, TIA, and TMVL events in the 15 days before and after CRAO.
RESULTS
Eighty-nine patients with a CRAO were identified, providing an annual incidence of 2.58/100 000 (95% confidence interval [CI], 2.04-3.11). Median age at the time of CRAO was 76 years (range, 46-100 years); 56.2% were male, and 89.9% of the cohort was White. In the 15 days before and after CRAO, there were 2 ischemic strokes (2.2%), 1 hemorrhagic stroke (1.1%), 2 TIAs (2.2%), and 9 TMVL events (10.1%). Starting in 1999, 15 of 45 patients underwent magnetic resonance imaging within 2 months of CRAO. One patient (6.7%) had evidence of asymptomatic diffusion restriction, and 9 patients (60%) had a remote infarct.
CONCLUSIONS
This population-based study demonstrated that the risk of symptomatic ischemic stroke is 2.2% in the 15 days before and after a CRAO, which is slightly lower than most studies from tertiary centers. These data should be considered as practice recommendations are developed regarding the urgency of neurovascular workup in patients with acute CRAO.
Topics: Aged; Aged, 80 and over; Amaurosis Fugax; Female; Humans; Incidence; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Middle Aged; Minnesota; Retinal Artery Occlusion; Retrospective Studies; Risk Factors; Stroke; Visual Acuity
PubMed: 34303745
DOI: 10.1016/j.ophtha.2021.07.017 -
Journal of Vascular Surgery Feb 2024The aim of this study was to investigate the natural history of internal carotid artery (ICA) stenosis progression.
OBJECTIVE
The aim of this study was to investigate the natural history of internal carotid artery (ICA) stenosis progression.
METHODS
This single-institution retrospective cohort study analyzed patients diagnosed with ICA stenosis of 50% or greater on duplex ultrasound from 2015 to 2022. Subjects were drawn from our institutional Intersocietal Accreditation Commission-accredited noninterventional vascular laboratory database. Primary outcomes were incidences of disease progression, and stroke or revascularization after index study. Progression was defined as an increase in stenosis classification category. Imaging, demographic, and clinical data was obtained from our institutional electronic medical record via a database mining query. Cases were analyzed at the patient and artery levels, with severity corresponding to the greatest degree of ICA stenosis on index and follow-up studies.
RESULTS
Of 577 arteries in 467 patients, mean cohort age was 73.5 ± 8.9 years at the time of the index study, and 45.0% (n = 210) were female. Patients were followed with duplex ultrasound for a mean of 42.2 ± 22.7 months. Of 577 arteries, 65.5% (n = 378) at the index imaging study had moderate (50%-69%) stenosis, 23.7% (n = 137) had severe (70%-99%) stenosis, and 10.7% (n = 62) were occluded. These three groups had significant differences in age, hypertension, hyperlipidemia prevalence, and proportion on best medical therapy. Of the 467-patient cohort, 56.5% (n = 264) were on best medical therapy, defined as smoking cessation, treatment with an antiplatelet agent, statin, and antihypertensive and glycemic agents as indicated. Mean time to progression for affected arteries was 28.0 ± 20.5 months. Of those arteries with nonocclusive disease at diagnosis, 21.3% (n = 123) progressed in their level of stenosis. Older age, diabetes, and a history of vasculitis were associated with stenosis progression, whereas antiplatelet agent use trended towards decreased progression rates. Of the 467 patients, 5.6% (n = 26) developed symptoms; of those, 38.5% (n = 10) had ischemic strokes, 26.9% (n = 7) had hemispheric transient ischemic attacks, 11.5% (n = 3) had amaurosis fugax, and 23.1% (n = 6) had other symptoms. A history of head and neck cancer was positively associated with symptom development. Of 577 affected arteries, 16.6% (n = 96) underwent intervention; 81% (n = 78) of interventions were for asymptomatic disease and 19% (n = 18) were for symptomatic disease. No patient-level factors were associated with risk of intervention.
CONCLUSIONS
A significant number of carotid stenosis patients experience progression of disease. Physicians should consider long-term surveillance on all patients with carotid disease, with increased attention paid to those with risk factors for progression, particularly those with diabetes and a history of vasculitis.
Topics: Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Carotid Stenosis; Retrospective Studies; Constriction, Pathologic; Platelet Aggregation Inhibitors; Carotid Artery, Internal; Disease Progression; Ultrasonography, Doppler, Duplex; Risk Factors; Diabetes Mellitus; Vasculitis
PubMed: 37925038
DOI: 10.1016/j.jvs.2023.10.059 -
Neurology India 2022Mechanical stimulation may lead to internal carotid artery (ICA) dissection and aneurysm.
BACKGROUND
Mechanical stimulation may lead to internal carotid artery (ICA) dissection and aneurysm.
CASE DESCRIPTION
We encountered a rare case of ICA dissection and aneurysm with prolonged styloid process (SP) fracture. A 37-year-old sales worker presented with right-sided amaurosis fugax. After admission to a nearby optical clinic, he was admitted to our hospital. Computed tomography angiography (CTA) and digital subtraction angiography showed dissection and apparent aneurysmal change in the right cervical portion of the ICA. CTA also showed elongated SPs, so we diagnosed Eagle's syndrome, and fracture of the right-side process. After 2 weeks of antiplatelet therapy, the aneurysm enlarged and dissection remained, so we treated the patient with coil embolization and stenting.
CONCLUSION
We encountered a rare case of ICA dissection and aneurysm with Eagle's syndrome. Endovascular treatment was performed because the SP was fractured.
Topics: Adult; Angiography, Digital Subtraction; Carotid Arteries; Carotid Artery, Internal; Carotid Artery, Internal, Dissection; Humans; Male; Ossification, Heterotopic; Temporal Bone
PubMed: 35263916
DOI: 10.4103/0028-3886.338648 -
Frontiers in Physiology 2019Carotid artery geometry influences blood flow disturbances and is thus an important risk factor for carotid atherosclerosis. Extracellular matrix (ECM) and...
OBJECTIVES
Carotid artery geometry influences blood flow disturbances and is thus an important risk factor for carotid atherosclerosis. Extracellular matrix (ECM) and yes-associated protein (YAP) expression may play essential roles in the pathophysiology of carotid artery stenosis, but the effect of blood flow disturbances of carotid bifurcation location on the ECM is unknown. We hypothesized that carotid artery anatomy and geometry are independently associated with the ECM and YAP expression.
METHODS
In this cross-sectional study, 193 patients were divided into two groups: an asymptomatic group ( = 111) and a symptomatic group ( = 82), symptomatic patients presenting with ischemic attack, amaurosis fugax, or minor non-disabling stroke. For all subjects before surgery, carotid bifurcation angle and internal artery angle were measured with computed tomography angiography (CTA), and laminar shear stress was measured with ultrasonography. After surgery, pathology of all plaque specimens was analyzed using hematoxylin and eosin (HE) staining and Movat special staining. Immunohistochemistry was performed to detect expression of YAP in a subset of 30 specimens.
RESULTS
Symptomatic patients had increased carotid bifurcation angle and laminar shear stress compared to asymptomatic patients ( < 0.05), although asymptomatic patients had increased internal carotid angle compared to symptomatic patients ( < 0.001). Relative higher bifurcation angles were correlated with increased carotid bifurcation, decreased internal angle, and decreased laminar shear stress. For each change in intervertebral space or one-third of vertebral body height, carotid bifurcation angle changed 4.76°, internal carotid angle changed 6.91°, and laminar shear stress changed 0.57 dynes/cm. Pathology showed that average fibrous cap thickness and average narrowest fibrous cap thickness were greater in asymptomatic patients than symptomatic patients ( < 0.05). Expression of proteoglycan and YAP protein in symptomatic patients was higher than in asymptomatic patients ( < 0.001), while collagen expression was lower in symptomatic patients than asymptomatic patients ( < 0.05).
CONCLUSION
Geometry of the carotid artery and position relative to cervical spine might be associated with ECM and YAP protein expression, which could contribute to carotid artery stenosis.
PubMed: 32038300
DOI: 10.3389/fphys.2019.01628 -
Lupus Feb 2023To study ophthalmological manifestations in a well-characterized primary antiphospholipid syndrome (PAPS) cohort (APS-Rio) and compare them with a healthy control group.
OBJECTIVE
To study ophthalmological manifestations in a well-characterized primary antiphospholipid syndrome (PAPS) cohort (APS-Rio) and compare them with a healthy control group.
METHODS
We examined PAPS patients and controls with an extensive ophthalmological evaluation, which included anamnesis, visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and retinography of the anterior and posterior segments of the eye. PAPS group also underwent angiography exam and optical coherence tomography using spectral domain technology (SD-OCT).
RESULTS
98 PAPS patients and 102 controls were included. The most common symptom in PAPS was amaurosis fugax (34.7% vs. 6.9%; = .001). In the multivariate analyses, Raynaud's phenomenon was associated with amaurosis fugax (OR 3.71, CI:1.33-10.32; = .012), and livedo correlated with hemianopia (OR 6.96, CI:1.11-43.72, = .038) and diplopia (OR 3.49, CI:1.02-11.53, = .047). After ophthalmological evaluation, 84 PAPS patients had ocular involvement (1.0% glaucoma, 94.0% posterior findings, 62.7% anterior findings, and 56.6% both posterior and anterior findings). Vascular tortuosity was more frequent in the PAPS group (63.2% vs. 42.2%; = .002), as well as peripheral tortuosity (29.6% vs. 7.8%; < .001). After excluding patients with atherosclerotic risk factors, peripheral vascular tortuosity was still statistically associated with PAPS (35.0 vs. 7.8%, < .001). Triple positivity was more frequent in PAPS patients with peripheral vascular tortuosity than in those without this ocular finding (34.5% vs. 15.9%, = .041).
CONCLUSION
Vasomotor phenomena are importantly related to ocular symptoms in PAPS. Vascular tortuosity was a frequent finding in PAPS patients. Peripheral vascular tortuosity was associated with triple positivity and might be a biomarker of ischemic microvascular retinopathy due to PAPS.
Topics: Humans; Antiphospholipid Syndrome; Amaurosis Fugax; Lupus Erythematosus, Systemic; Retinal Diseases; Arteries
PubMed: 36444940
DOI: 10.1177/09612033221143294 -
European Journal of Ophthalmology Mar 2020The risk of developing stroke after retinal artery occlusion was reported to be increased. The aim of our study was to assess the rate of strokes/transitory ischemic...
BACKGROUND
The risk of developing stroke after retinal artery occlusion was reported to be increased. The aim of our study was to assess the rate of strokes/transitory ischemic attacks after retinal artery occlusion in a European population and to identify the risk groups.
METHODS
All patients, diagnosed with branch or central retinal artery occlusion at our outpatient department since 2014, were asked to participate in this prospective case-control study. At the initial examination, the medical history was documented and 1 year after retinal artery occlusion, patients were called by telephone interview for assessment of the rate of strokes/transitory ischemic attack in the follow-up period.
RESULTS
In all, 30 eyes of 30 patients could be included. Among these, six patients had a stroke, one a transitory ischemic attack, and one an amaurosis fugax in the medical history before retinal artery occlusion. In the period 1 year after retinal artery occlusion, one patient had a re-stroke and one patient had a transitory ischemic attack, with amaurosis fugax in the medical history. Rates of strokes/transitory ischemic attack before and after retinal artery occlusion did not show significant differences between branch and central artery occlusion.
CONCLUSION
The number of strokes/transitory ischemic attacks within the first year is relatively low after retinal artery occlusion and patients that already had a previous stroke, transitory ischemic attack, and/or amaurosis fugax before retinal artery occlusion seem to have a higher risk for a cerebrovascular event after retinal artery occlusion.
Topics: Adult; Aged; Case-Control Studies; Europe; Female; Humans; Incidence; Ischemic Attack, Transient; Male; Middle Aged; Prospective Studies; Retinal Artery Occlusion; Risk Factors; Stroke
PubMed: 30782009
DOI: 10.1177/1120672119830925 -
Diagnosis and Treatment of Ophthalmic Artery Stenosis Causing Recurrent Ipsilateral Amaurosis Fugax.Journal of Neuro-ophthalmology : the... Apr 2024
PubMed: 38578705
DOI: 10.1097/WNO.0000000000002141 -
Seminars in Arthritis and Rheumatism Oct 2022To investigate the risk of ocular manifestations leading to hospital contacts among patients with giant cell arteritis (GCA).
OBJECTIVES
To investigate the risk of ocular manifestations leading to hospital contacts among patients with giant cell arteritis (GCA).
METHODS
A Danish, nationwide, register-based cohort study including 14,574 GCA patients diagnosed 1996-2018 and 145,740 general population referents, matched on sex and date of birth. Cumulative incidence proportions (CIPs) and relative risks (RRs) of ocular manifestations with 95% confidence intervals (CIs) were calculated using a pseudo-observation approach.
RESULTS
A total of 1026/14,574 (7.0%) GCA patients were registered with ocular manifestations within ±1 year of the diagnosis; 392/1026 (38%) being before and 634/1026 (62%) after the GCA diagnosis, and 744/1026 (73%) were registered within ±1 month of the diagnosis. The diagnoses were 336/1026 (33%) retinal vascular occlusions, 300/1026 (29%) disorders of the optic nerve, 177/1026 (17%) visual impairment, 90/1026 (9%) diplopia, and 123/1026 (12%) amaurosis fugax. The CIP for ocular manifestations among GCA patients after 3, 6, and 12 months following the diagnosis were 4.0% (95% CI: 3.6-4.3), 4.2% (95% CI: 3.9-4.6), and 4.6% (95% CI: 4.2-4.9). The 1-year RR of ocular manifestations among GCA patients was 28.0 (95% CI: 24.0-32.7), with age above 70 years, male sex, and a positive temporal artery biopsy being risk factors. Treatment with low-dose aspirin was not associated with a reduced 1-year RR of incident ocular manifestations.
CONCLUSIONS
In GCA, most cases of ocular manifestations leading to hospital contacts occur close to the time of diagnosis, with over one-third of cases occurring before the diagnosis, emphasizing the need for early recognition and treatment.
Topics: Aged; Biopsy; Cohort Studies; Giant Cell Arteritis; Hospitals; Humans; Incidence; Male; Retrospective Studies
PubMed: 35878473
DOI: 10.1016/j.semarthrit.2022.152071 -
Cureus May 2021Tolosa-Hunt syndrome (THS) is a fascinating condition that is ipso facto a cavernous sinus syndome. As such it is associated with inflammation of the cavernous sinus...
Tolosa-Hunt syndrome (THS) is a fascinating condition that is ipso facto a cavernous sinus syndome. As such it is associated with inflammation of the cavernous sinus walls and contents with spread to contiguous structures such as the orbital apex and superior orbital fissure. Therefore it does not come as a surprise that there is overlap with the condition of orbital pseudotumor. Furthermore, the typical presentation of THS involves variable affliction of the contents of the cavernous sinus with ocular and facial pain, ophthalmoplegia, facial numbness and Horner syndrome. To our knowledge, we present one of the only reported cases of recurrent amaurosis fugax and transient visual obscurations secondary to THS. Despite being an odd-ball presentation, these manifestations make intuitive sense as we demonstrate luminal narrowing of the right carotid siphon in the setting of cavernous wall enhancement, peri-arteritis of the carotid siphon being well-documented pathologically in the literature. The basis for the transient visual obscurations is more speculative but worthy of further study.
PubMed: 34221749
DOI: 10.7759/cureus.15281 -
World Neurosurgery Nov 2022The outcomes of carotid revascularization among octogenarians are not well studied. We present analyses of 30-day stroke and mortality of patients aged ≥80 years using...
Thirty-Day Stroke and Mortality After Carotid Revascularization Among Octogenarians with Symptomatic Carotid Stenosis: Real-World Evidence from a National Surgical Quality Registry.
BACKGROUND
The outcomes of carotid revascularization among octogenarians are not well studied. We present analyses of 30-day stroke and mortality of patients aged ≥80 years using real-world data from a national surgical quality registry.
METHODS
The National Surgical Quality Improvement Program targeted data set for carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) was queried for patients aged ≥80 years undergoing CEA and CAS between 2012 and 2019.
RESULTS
A total of 122 and 3013 patients aged ≥80 years with symptomatic carotid stenosis undergoing CAS and CEA, respectively, were identified. Patients with CAS were more likely to be older than 90 years (P = 0.006) and have diabetes (P = 0.036), were more likely to have high-risk anatomy (P < 0.001), but had lower American Society of Anesthesiologists score (P < 0.001). An ipsilateral stroke had been experienced by 43.6% of patients with CAS and 44.7% of patients with CEA. The rate of 30-day composite outcome was 6.4% in the CAS group and 4.5% in the CEA group (P = 0.326). The f 30-day mortality was significantly higher for CAS (5.6% vs. 1.7%, P = 0.001); however, the difference between the cohorts was not significant (CAS, 2.4% vs. CEA, 3.4%, P = 0.555). On multivariable analysis, CEA was associated with significantly lower odds of mortality (odds ratio [OR], 0.32; P = 0.0145). Symptom presentation other than ipsilateral stroke was associated with significantly decreased odds of 30-day outcome (amaurosis fugax/transient monocular blindness, OR, 0.39, P = 0.004; transient ischemic attack, OR, 0.57, P = 0.003), whereas higher age had significantly increased odds (OR, 1.95; P = 0.0172).
CONCLUSIONS
Real-world analyses from a surgical quality registry show that CEA may be associated with lower odds of mortality compared with CAS among octogenarians.
Topics: Aged, 80 and over; Humans; Carotid Stenosis; Octogenarians; Risk Factors; Risk Assessment; Myocardial Infarction; Treatment Outcome; Stroke; Endarterectomy, Carotid; Registries; Stents; Retrospective Studies
PubMed: 35863648
DOI: 10.1016/j.wneu.2022.07.056