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  • Increase in stroke complications seen several days before and after CRAO

    Neuro-Ophthalmology/Orbit, Retina/Vitreous

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    Review of: Stroke risk before and after central retinal artery occlusion: A population-based analysis

    Chodnicki K, Tanke L, Pulido J, et al. Ophthalmology, February 2022

    This population-based, retrospective case series study of patients enrolled in the Rochester Epidemiology Project evaluated the association of stroke in the 15 days before and after central retinal artery occlusion (CRAO).

    Study design

    Charts of patients living in Olmsted County, Minnesota, who were diagnosed with CRAO in a 40-year window were reviewed. Risk assessment of other neurovascular events, including cerebrovascular accidents, transient ischemic attacks (TIAs), and transient monocular vision loss (TMVL), were evaluated.

    Outcomes

    Eighty-nine patients with a CRAO during the time period were identified, providing an annual incidence rate of 2.58/100,000. The median age at the time of CRAO was 76 years, and 56.2% of patients were male. In the 15 days before and after CRAO, 2 patients had ischemic strokes and 1 patient had a nonischemic stroke (3.4% of the study population). In addition, 2.2% of patients had a TIA and 10.1% experienced TVML.

    Limitations

    A major limitation of this study was the inherent bias of its retrospective design. In addition, the study spanned several decades; hence, practice patterns as well as diagnostic evaluations and treatments changed significantly over the time period. Finally, the generalizability of the results is limited as nearly 90% of the CRAO cohort was White.

    Clinical significance

    In 2021, the American Heart Association published a scientific statement which stressed that CRAO is a medical emergency requiring an emergent workup. This is because CRAO is thought to be the equivalent of a stroke or TIA. Of note, in this study, all of the patients who developed a stroke or TIA in the time period before and after CRAO had an embolic etiology, outlining the importance of evaluating for embolus in the period following CRAO. Although patients often are not diagnosed with CRAO in the acute period, this study underlines the importance of a full stroke workup in the acute period to help prevent neurovascular events. Further research to investigate whether an emergent stroke workup improves outcomes would be beneficial.