Stroke Risk Before and After Central Retinal Artery Occlusion in a US Cohort

Objective: To determine the risk of ischemic stroke, transient ischemic attack (TIA), and amaurosis fugax around the time of central retinal artery occlusion (CRAO). Patients and Methods: Patients at Mayo Clinic sites with a diagnosis code of CRAO from January 1, 2001, through September 9, 2016, were reviewed. New CRAOs were confirmed, and ischemic stroke, TIA, and amaurosis fugax events were tallied within 15 days before and after CRAO. Results: Three hundred patients with CRAO were included in the study cohort. The median age at the time of CRAO was 72 years (range, 19-100 years), and 158 (53%) were male patients. Overall, 16 patients (5.3%) had symptomatic ischemic stroke around the time of CRAO, with 7 strokes (2.3%) occurring 15 days before CRAO, 4 (1.3%) occurring simultaneously with CRAO, and 5 (1.7%) occurring after CRAO. Transient ischemic attack and amaurosis fugax were seen in 5 (1.7%) and 26 (8.7%) patients, respectively. It was found that 7% (9/128) of patients with embolic CRAO had a stroke around the time of CRAO as compared with 1.3% (2/149) of patients with an unknown cause of CRAO. Conclusion: Symptomatic stroke, TIA, or amaurosis fugax is common around the time of CRAO. Therefore, CRAOs require urgent embolic work-ups. (C) 2018 Mayo Foundation for Medical Education and Research.