Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion
Abstract Background Ischemic stroke (IS) and retinal ischemia (IR) share similar vascular risk factors, but differ in their risk for subsequent or recurrent stroke and therapeutic options. This study characterizes the cardiovascular risk profiles and magnitude of atherosclerosis of the carotid arter...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
|
| Series: | Neurological Research and Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42466-025-00413-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849235588756013056 |
|---|---|
| author | Felix Schlachetzki Ina Feistenauer Michael Ertl Mustafa Kilic Fabian Aden David Pollinger Horst Helbig Christina Wendl Karin Pfister Lars Krenkel Maria Andreea Gamulescu Ralf Andreas Linker Sibylle Wilfling |
| author_facet | Felix Schlachetzki Ina Feistenauer Michael Ertl Mustafa Kilic Fabian Aden David Pollinger Horst Helbig Christina Wendl Karin Pfister Lars Krenkel Maria Andreea Gamulescu Ralf Andreas Linker Sibylle Wilfling |
| author_sort | Felix Schlachetzki |
| collection | DOAJ |
| description | Abstract Background Ischemic stroke (IS) and retinal ischemia (IR) share similar vascular risk factors, but differ in their risk for subsequent or recurrent stroke and therapeutic options. This study characterizes the cardiovascular risk profiles and magnitude of atherosclerosis of the carotid artery of patients with central retinal artery occlusion (CRAO) in relation to the presence of the retrobulbar “spot sign” on orbital color-coded sonography (OCCS). Methods We performed a retrospective analysis on the detailed cardiovascular risk factors and neuroimaging data in patients with IR presenting between 2009 and 2023. Based on OCCS findings, CRAO were further divided into hyperechoic (“spot sign positive”, ssCRAO) or hypoechoic CRAO (heCRAO). Statistical analyses were performed with Mann-Whitney-U and χ [2] testing. P-values were considered significant if < 0.05. Results Overall, 112 patients were identified (heCRAO: n = 32; ssCRAO: n = 80). ssCRAO patients were significantly older (median 74 years vs. 66.5 years, Mann-Whitney-U: p-value < 0.001). Overall, 15/103 (14.6%) patients had concurrent acute ischemic stroke– 9 in the ipsilateral internal carotid territory, 2 in other territories and 4 disseminated. Further significant differences were found regarding the echogenicity of atherosclerosis (AS) in the two subgroups with (mainly) echorich AS being more common in the ssCRAO group (p-value < 0.001, n = 108) and the distribution of high-grade vs. low-grade stenoses of the ipsi- and contralateral carotid artery (p-value < 0.05, n = 99). 20 out of 112 patients had atrial fibrillation (aFib) with 17 of these being on ongoing oral anticoagulation. Conclusion According to this study, atherosclerosis may be one of the most important risk factors for IR while a specific embolic source could not be demonstrated (i.e. acute plaque rupture). By contrast, current oral anticoagulation for aFib in CRAO patients was high, thus only an incidental finding and may be an incidental finding due to its prevalence in the elderly. Furthermore, we were able to distinguish two subgroups of IR that differ in risk factors and most likely also in etiology, therapy and prognosis. The study underlines the importance of OCCS to detect “spot signs” in IR with indications for both, acute thrombolysis and secondary prevention. |
| format | Article |
| id | doaj-art-060f5d901b1c44cda8e15f88cb135770 |
| institution | Kabale University |
| issn | 2524-3489 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Neurological Research and Practice |
| spelling | doaj-art-060f5d901b1c44cda8e15f88cb1357702025-08-20T04:02:44ZengBMCNeurological Research and Practice2524-34892025-07-017111210.1186/s42466-025-00413-zRetinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusionFelix Schlachetzki0Ina Feistenauer1Michael Ertl2Mustafa Kilic3Fabian Aden4David Pollinger5Horst Helbig6Christina Wendl7Karin Pfister8Lars Krenkel9Maria Andreea Gamulescu10Ralf Andreas Linker11Sibylle Wilfling12Department of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Neurology and Neurorehabilitation, University HospitalDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Ophthalmology, University Hospital RegensburgCenter for Neuroradiology, University Hospital Regensburg and medbo BezirksklinikumDepartment of Vascular and Endovascular Surgery, University Hospital RegensburgDepartment of Biofluidmechanics, Technical University of Applied Sciences (OTH) RegensburgDepartment of Ophthalmology, University Hospital RegensburgDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgDepartment of Neurology, TEMPiS Telestroke Center, University of Regensburg, medbo Bezirksklinikum, and University Hospital RegensburgAbstract Background Ischemic stroke (IS) and retinal ischemia (IR) share similar vascular risk factors, but differ in their risk for subsequent or recurrent stroke and therapeutic options. This study characterizes the cardiovascular risk profiles and magnitude of atherosclerosis of the carotid artery of patients with central retinal artery occlusion (CRAO) in relation to the presence of the retrobulbar “spot sign” on orbital color-coded sonography (OCCS). Methods We performed a retrospective analysis on the detailed cardiovascular risk factors and neuroimaging data in patients with IR presenting between 2009 and 2023. Based on OCCS findings, CRAO were further divided into hyperechoic (“spot sign positive”, ssCRAO) or hypoechoic CRAO (heCRAO). Statistical analyses were performed with Mann-Whitney-U and χ [2] testing. P-values were considered significant if < 0.05. Results Overall, 112 patients were identified (heCRAO: n = 32; ssCRAO: n = 80). ssCRAO patients were significantly older (median 74 years vs. 66.5 years, Mann-Whitney-U: p-value < 0.001). Overall, 15/103 (14.6%) patients had concurrent acute ischemic stroke– 9 in the ipsilateral internal carotid territory, 2 in other territories and 4 disseminated. Further significant differences were found regarding the echogenicity of atherosclerosis (AS) in the two subgroups with (mainly) echorich AS being more common in the ssCRAO group (p-value < 0.001, n = 108) and the distribution of high-grade vs. low-grade stenoses of the ipsi- and contralateral carotid artery (p-value < 0.05, n = 99). 20 out of 112 patients had atrial fibrillation (aFib) with 17 of these being on ongoing oral anticoagulation. Conclusion According to this study, atherosclerosis may be one of the most important risk factors for IR while a specific embolic source could not be demonstrated (i.e. acute plaque rupture). By contrast, current oral anticoagulation for aFib in CRAO patients was high, thus only an incidental finding and may be an incidental finding due to its prevalence in the elderly. Furthermore, we were able to distinguish two subgroups of IR that differ in risk factors and most likely also in etiology, therapy and prognosis. The study underlines the importance of OCCS to detect “spot signs” in IR with indications for both, acute thrombolysis and secondary prevention.https://doi.org/10.1186/s42466-025-00413-zRetinal ischemiaSpot signOrbital color coded sonographyAtherosclerosisCholesterol emboliCentral retinal artery occlusion |
| spellingShingle | Felix Schlachetzki Ina Feistenauer Michael Ertl Mustafa Kilic Fabian Aden David Pollinger Horst Helbig Christina Wendl Karin Pfister Lars Krenkel Maria Andreea Gamulescu Ralf Andreas Linker Sibylle Wilfling Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion Neurological Research and Practice Retinal ischemia Spot sign Orbital color coded sonography Atherosclerosis Cholesterol emboli Central retinal artery occlusion |
| title | Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion |
| title_full | Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion |
| title_fullStr | Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion |
| title_full_unstemmed | Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion |
| title_short | Retinal ischemia due to different stages of atherosclerosis - insights from a retrospective study on central retinal artery occlusion |
| title_sort | retinal ischemia due to different stages of atherosclerosis insights from a retrospective study on central retinal artery occlusion |
| topic | Retinal ischemia Spot sign Orbital color coded sonography Atherosclerosis Cholesterol emboli Central retinal artery occlusion |
| url | https://doi.org/10.1186/s42466-025-00413-z |
| work_keys_str_mv | AT felixschlachetzki retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT inafeistenauer retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT michaelertl retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT mustafakilic retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT fabianaden retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT davidpollinger retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT horsthelbig retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT christinawendl retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT karinpfister retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT larskrenkel retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT mariaandreeagamulescu retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT ralfandreaslinker retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion AT sibyllewilfling retinalischemiaduetodifferentstagesofatherosclerosisinsightsfromaretrospectivestudyoncentralretinalarteryocclusion |