Associations of retinal microvascular signs and intracranial large artery disease.
ABSTRACT Intracranial large artery disease (ICLAD) is a major cause of ischemic stroke. Retinal microvascular changes are associated with stroke, including small vessel cerebral disease and extracranial carotid disease. We examined the relationship between ICLAD and retinal microvascular changes.
This is a prospective cohort of 802 acute ischemic stroke patients. Retinal changes were assessed from photographs by graders masked to clinical data. ICLAD was evaluated using prespecified criteria.
ICLAD was not associated with ipsilateral retinal arteriolar/venular caliber, focal arteriolar narrowing, or arteriovenous nicking. Severe enhanced arteriolar light reflex was independently associated with any ICLAD (P=0.006) and severe ICLAD (P<0.001).
Enhanced arteriolar light reflex, but not retinal vessel caliber, was related to ICLAD. These data suggest that retinal microvascular signs have specific associations with large cerebral vessel disease.
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ABSTRACT: Low ankle-brachial index (ABI), indicative of peripheral arterial disease (PAD), is a risk factor for stroke. ABI has been shown to be associated with cerebral arterial disease and prognosis following stroke. We studied the associations of the degree of ABI lowering with extracranial carotid disease (ECD), intracranial large artery disease (ICLAD), and subsequent vascular events in a prospective cohort of acute ischemic stroke patients. ABI, extracranial and intracranial cerebral arteries were assessed in a blinded manner. ABI was categorized into 0.9-1.3 (normal), 0.8-0.89 (mildly lowered) and <0.8 (severely lowered). Follow-up data at 1 year were obtained from standardized telephone interviews and verified with medical records. Among the 1311 patients, 73% had normal ABI, 13% had ABI 0.8-0.89 and 13% had ABI <0.8. Compared to patients with normal ABI, those with ABI<0.8 had higher prevalence of severe ECD (15% vs. 5%, p = 0.006) and ICLAD (72% vs. 48%, p = 0.003), even after adjustment for age, gender, hypertension, diabetes, hyperlipidemia, smoking, ischemic heart disease and atrial fibrillation (severe ECD p < 0.001, ICLAD p < 0.001). At 1 year, patients with ABI <0.8 had a higher incidence of composite vascular events (19% vs. 11%, p = 0.02), stroke (15% vs. 10%, p = 0.06) and myocardial infarction (4% vs. 2%, p = 0.07) than patients with normal ABI. Among ischemic stroke patients, large cerebral arterial disease and incidence of subsequent vascular events at 1 year were associated with severe ABI lowering <0.8, but not with mild ABI lowering (0.8-0.89).Atherosclerosis 05/2012; 223(1):219-22. · 3.71 Impact Factor
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ABSTRACT: In utero insults that result in low-birth-weight (LBW) infants are now recognized risk factors for the development of vascular-related diseases in adulthood. Microcirculatory pathologies are believed to form a mechanistic link between fetal insult and the manifestation of illness in adulthood. The challenge has been to investigate microcirculatory changes in vivo. The objective of this review is to determine whether LBW infants and individuals undergo abnormal microvascular changes and, if so, whether these changes can be objectively identified and measured by investigating retinal vessels. An online publication search was carried out using the following keywords to identify and review relevant articles: retinal microvasculature, retinal vessels, small for gestation age, growth restriction, and intrauterine growth restriction. Articles published from 1980 to 2011 were considered. The ability of retinal imaging technology to assess and measure retinal microvasculature makes it a valuable assessment tool. The current tool is, however, unsuitable for non-invasive assessment in infants and young children. Once this hurdle has been overcome, a longitudinal study of LBW individuals from infancy to adulthood, with regular retinal microvascular assessments, would help prove the mechanistic link between LBW and cardiovascular disease in adulthood.Journal of Perinatal Medicine 12/2011; 40(3):209-14. · 1.95 Impact Factor