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Atherosclerotic carotid artery disease in patients with retinal ischemic syndromes

From the Department of Neurology, University of Pennsylvania, and the Neuro ophthalmology Service (Drs. Bosley, Cohen, and Savino), Wills Eye Hospital, Philadelphia, PA.

The extracranial carotid systems of 105 patients with retinal ischemia were examined using B-mode ultrasonography with integrated pulsed Doppler. Sixty-four patients had amaurosis fugax (AF), 17 central retinal artery occlusions (CRAO), and 21 branch retinal artery occlusions (BRAO). The prevalence of carotid stenosis (60%) ipsilateral to the symptomatic eye was low (16%). Eighty-six percent of AF patients had either no plaque or plaque causing less than a 60% stenosis. A significant proportion of subjects with normal duplex scans had alternative explanations for their retinal ischemia (eg, migraine, cardiac embolus). Patients with Hollenhorst plaques were more likely to have stenotic or ulcerated plaque (p = 0.04). The degree of carotid stenosis correlated significantly with the number of vascular risk factors identified in individual patients (p = 0.02). The presence of risk factors was more common in CRAO and BRAO patients compared with the AF group. Combined ultrasound-Doppler investigations of the carotid bifurcation are valuable noninvasive tools for the screening of patients with retinal ischemia.

Address correspondence and reprint requests to Dr. Chawluk, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

Presented in part at the thirty-eighth annual meeting of the American Academy of Neurology, New Orleans, LA, April 1986.

Received September 29, 1987. Accepted for publication in final form October 16, 1987.

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