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

S. F. Cheng, A. Zarkali, T Richards, R Simister, A. Chandratheva

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalAnnals of the Royal College of Surgeons of England
DOIs
Publication statusE-pub ahead of print - 3 Jun 2019
Externally publishedYes

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Carotid Stenosis
Stroke
Recurrence
Ischemia
Transient Ischemic Attack
Pathologic Constriction
Magnetic Resonance Angiography
Hypercholesterolemia
Causality
Blood Vessels
Smoking
Tomography
Hypertension

Cite this

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title = "Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss",
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.",
author = "Cheng, {S. F.} and A. Zarkali and T Richards and R Simister and A. Chandratheva",
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Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss. / Cheng, S. F.; Zarkali, A.; Richards, T; Simister, R; Chandratheva, A.

In: Annals of the Royal College of Surgeons of England, 03.06.2019, p. 1-5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss

AU - Cheng, S. F.

AU - Zarkali, A.

AU - Richards, T

AU - Simister, R

AU - Chandratheva, A.

PY - 2019/6/3

Y1 - 2019/6/3

N2 - 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.

AB - 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.

U2 - 10.1308/rcsann.2019.0071

DO - 10.1308/rcsann.2019.0071

M3 - Article

SP - 1

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JO - Annals of the Royal College of Surgeons England

JF - Annals of the Royal College of Surgeons England

SN - 0035-8843

ER -