Retinal vascular caliber and extracranial carotid disease in patients with acute ischemic stroke: the Multi-Centre Retinal Stroke (MCRS) study.
OBJECTIVE
Previous studies show that both retinal vascular caliber and carotid disease predict incident stroke in the general population, but the exact relationship between these 2 microvascular and macrovascular structural risk factors is unclear. We studied the relationship between retinal vascular caliber and carotid disease in patients presenting with acute ischemic stroke.


METHODS
We conducted a cross-sectional study of patients with acute ischemic stroke recruited from 3 centers (Melbourne, Sydney, Singapore). The caliber of retinal arterioles and venules was measured from digital retinal photographs. Severe extracranial carotid disease was defined as stenosis >or=75% or occlusion determined by carotid Doppler using North American Symptomatic Carotid Endarterectomy Trial-based criteria.


RESULTS
Among the 1029 patients with acute stroke studied, 7% of the population had severe extracranial carotid disease. Retinal venular caliber was associated with ipsilateral severe carotid disease (P<0.001 in multivariate models). Patients with wider retinal venular caliber were more likely to have severe ipsilateral carotid disease (multivariable-adjusted OR, 3.81; 95% CI, 1.80 to 8.07, comparing the largest and smallest venular caliber quartiles). The retinal venular caliber-carotid disease association remained significant in patients with large artery stroke.


CONCLUSIONS
In patients with acute stroke, retinal venular widening was strongly associated with ipsilateral severe extracranial carotid disease. Our findings suggest concomitant retinal and cerebral microvascular disease may be present in patients with carotid stenosis or occlusion disease. The pathogenesis of stroke due to carotid disease may thus be partially mediated by microvascular disease.
De Silva
Deidre A
DA
Singapore General Hospital Campus, National Neuroscience Institute, Singapore. gnrdsd@sgh.com.sg
Liew
Gerald
G
Wong
Meng-Cheong
MC
Chang
Hui-Meng
HM
Chen
Christopher
C
Wang
Jie Jin
JJ
Baker
Michelle L
ML
Hand
Peter J
PJ
Rochtchina
Elena
E
Liu
Erica Yang
EY
Mitchell
Paul
P
Lindley
Richard I
RI
Wong
Tien Yin
TY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001160:Arterioles / Q000473:pathology / Q000503:physiopathology; D001315:Australia / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012161:Retinal Artery / Q000473:pathology / Q000503:physiopathology; D015356:Retinal Artery Occlusion / Q000453:epidemiology* / Q000503:physiopathology; D012169:Retinal Vein / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D018608:Ultrasonography, Doppler; D014699:Venules / Q000473:pathology / Q000503:physiopathology