Is carotid ultrasound necessary in the clinical evaluation of the asymptomatic Hollenhorst plaque? (An American Ophthalmological Society thesis).
OBJECTIVE
To evaluate the utility of carotid ultrasound in patients with asymptomatic Hollenhorst plaques.


METHODS
Retrospective chart review of 237 patients diagnosed with Hollenhorst plaques between 1996 and 2004. The baseline cardiovascular risk profile, medications, and carotid ultrasound findings were documented. Retinal ischemia, myocardial ischemia, and cerebrovascular events during follow-up were noted.


RESULTS
There was no statistically significant difference in the proportion of patients with carotid stenosis >40% between symptomatic (n=60) and asymptomatic (n=177) patients (32.7% vs 22.7%; P=.192, one-way ANOVA). However, symptomatic patients were statistically more likely to have stenosis >69% (25% compared with 9.2% in the asymptomatic group; P=.008, one-way ANOVA). Among asymptomatic patients, those with carotid bruit (27.1%) were more likely to have moderate carotid stenosis >40% (55.6% vs 18.6% in patients without bruit; P=.0008, one-way ANOVA) and significant stenosis >69% (37% vs 4.3% in patients without bruit; P=.0001, one-way ANOVA). Follow-up data was obtained from 32 symptomatic patients (39.6 ± 22.9 months) and 100 asymptomatic patients (41.3 ± 21.8 months). Vascular and neurologic event rates were similar between the two groups.


CONCLUSIONS
Hollenhorst plaques are a marker of significant carotid disease irrespective of retinal symptoms. Carotid auscultation remains important in the examination of patients with Hollenhorst plaques and increases the yield of asymptomatic patients diagnosed with carotid stenosis. The presence of visual symptoms on presentation did not correlate with an increased risk of death or stroke compared to asymptomatic patients during follow-up. Therefore all patients with asymptomatic plaques should have a medical workup, including carotid ultrasonography.
Department of Ophthalmology (Dr Bakri, Dr Pathik), Department of Internal Medicine (Dr Luqman), and Department of Cardiovascular Diseases (Dr Chandrasekaran), Mayo Clinic, Rochester, Minnesota.
Sophie J
SJ
Bakri
Ashraf
A
Luqman
Bhupesh
B
Pathik
Krishnaswamy
K
Chandrasekaran
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D017700:Embolism, Cholesterol / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012164:Retinal Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D014463:Ultrasonography