Relationship of extracranial carotid occlusive disease and central retinal artery occlusion

doi:10.1016/0002-9610(86)90237-0

The American Journal of Surgery

Volume 152, Issue 2, August 1986, Pages 175-178

https://doi.org/10.1016/0002-9610(86)90237-0 Get rights and content

Abstract

Central retinal artery occlusion usually results in blindness. The association between central retinal artery occlusion and extracranial carotid disease has not been clearly delineated. We reviewed the case reports of 62 patients with central retinal artery occlusion, 25 of whom underwent carotid angiography as part of the diagnostic evaluation. Fourteen of the 25 (56 percent) were found to have ipsilateral extracranial carotid disease. These patients did not generally have carotid bruits and had normal noninvasive carotid tests. Ten patients underwent ipsilateral carotid endarterectomy; these patients had either embologenic ulcerated plaque or tight stenosis of the carotid artery. There were 11 patients who showed no abnormalities on angiography. Thirteen patients who did not undergo angiography showed clinical evidence of etiologic factors, including vasculitis, an embolism of cardiac origin, and trauma. The remaining 24 patients had no diagnostic workup. Follow-up data were available in six of those patients who underwent carotid endarterectomy for a mean of 34 months; no strokes were reported. In conclusion, over half of patients with central retinal artery occlusion who undergo carotid angiography will have a carotid lesion on the ipsilateral side. This suggests that central retinal artery occlusion is a significant marker for extracranial carotid disease and should be an indication for complete carotid evaluation.

References (13)

RW Hollenhorst
Vascular status of patients who have cholesterol emboli in the retina
Am J Ophthalmol
(1966)
RL Kirshner et al.
Ocular manifestations of carotid artery atheroma
J Vasc Surg
(1985)
ND Caltrider et al.
Retinal emboli in patients with mitral valve prolapse
Am J Ophthalmol
(1980)
LM Jampol et al.
Atrial myxoma and central retinal artery occlusion
Am J Ophthalmol
(1973)
GC Brown et al.
Retinal arterial obstruction in children and young adults
Ophthalmology
(1981)
HG Shah et al.
Digital subtraction carotid angiography and retinal arterial obstruction
Ophthalmology
(1985)

There are more references available in the full text version of this article.

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Citation Excerpt :
Atherosclerotic disease of the carotid artery is believed to be the most common source of emboli resulting in the disruption of retinal artery blood flow. Although the data are largely from small case series, the prevalence of carotid artery disease in those who have CRAO is generally believed to be 10% to 25%, although there is literature suggesting rates as high as 70% [49,51–55]. Additionally, CRAO in the setting of carotid disease may portend an increased risk for stroke; for this reason, carotid endarterectomy is often recommended in this setting [55].
Acute monocular visual loss is an alarming symptom for the patient and the emergency physician. This article focuses on the presentation, diagnosis, and management of several causes of acute monocular visual loss with suggestions for when to emergently involve an ophthalmologist. Topics discussed include temporal arteritis, optic neuritis, retinal artery occlusion, retinal vein occlusion, retinal detachment, and retinal vasculitis.

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^☆: Presented at the 14th Annual Meeting of the Society for Clinical Vascular Surgery, Orlando, Florida, April 9–13, 1986.

¹: From the Department of Surgery, University of California, Los Angeles School of Medicine, Los Angeles, California.

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Scientific paperRelationship of extracranial carotid occlusive disease and central retinal artery occlusion☆

Abstract

Am J Ophthalmol

J Vasc Surg

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Scientific paper
Relationship of extracranial carotid occlusive disease and central retinal artery occlusion☆