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Observational Study
. 2019 Nov;101(8):579-583.
doi: 10.1308/rcsann.2019.0071. Epub 2019 Jun 3.

Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss

S F Cheng  1   2 , A Zarkali  3 , T Richards  1   2 , R Simister  3 , A Chandratheva  3
Affiliations
Observational Study

Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss

S F Cheng et al. Ann R Coll Surg Engl. 2019 Nov.

Abstract

Introduction: Isolated monocular ischaemic events are thought to be low risk for stroke recurrence. In the presence of carotid stenosis however, the risks should not be treated similarly and surgical intervention should be considered at an early stage. The aim of this study was to determine the vascular risk profile and stroke recurrence in patients with ischaemic monocular visual loss.

Methods and methods: Consecutive records for all patients with monocular ischaemia were reviewed from January 2014 to October 2016. Stroke, transient ischaemic attack or monocular ischaemia recurrence within 90 days were recorded. Carotid stenosis was assessed with duplex ultrasound, computed tomography or magnetic resonance angiography.

Results: In total, 400 patients presented with monocular ischaemia; 391 had carotid imaging (97.8%). Causality was symptomatic carotid stenosis ≥ 50% in 53 (13.6%), including carotid stenosis ≥ 70% in 31 (7.9%). Patients with permanent visual loss (n = 131) were more likely to have significant stenosis compared with patients with transient visual loss (n = 260), 19.8% compared with 10.4% (P = 0.012). Recurrent stroke, transient ischaemic attack or monocular ischaemia within 90 days after presentation occurred in three patients (5.7%) in the carotid stenosis group, compared to three (0.9%) who did not have stenosis (P = 0.035). Age, male sex and hypertension were associated with carotid stenosis but hypercholesterolaemia, diabetes and smoking were not.

Conclusions: Carotid stenosis ≥ 50% is present in patients with ocular ischaemia in approximately 20% of those with persistent visual loss and in 10% with transient visual loss. Those with carotid stenosis have a higher risk of stroke recurrence and should be considered urgent surgical intervention as other forms of stroke.

Keywords: Amaurosis fugax; Carotid stenosis: Carotid endarterectomy; Monocular blindness; Stroke.

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References

    1. Bernstein EF. Amaurosis Fugax. New York: Springer-Verlag; 1987, pp. 286–303.
    1. Kappelle LJ, Donders RCJM, Algra A. Transient monocular blindness. Clin Exp Hypertens 2006; (3–4): 259–263. - PubMed
    1. Fisher CM. Transient monocular blindness ‘versus’ amaurosis fugax. Neurology 1989; : 1,622–1,624. - PubMed
    1. The Amaurosis Fugax Study Group: current management of amaurosis fugax. Stroke 1990; (2): 201–208. - PubMed
    1. Adams HP, Bendixen BH, Kappelle LJ et al. . Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; : 35–41. - PubMed

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