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(Stroke. 2009;40:3695.)
© 2009 American Heart Association, Inc.

Original Contributions

Retinal Vascular Caliber and Extracranial Carotid Disease in Patients With Acute Ischemic Stroke

The Multi-Centre Retinal Stroke (MCRS) Study

Deidre A. De Silva, MRCP; Gerald Liew, MMed; Meng-Cheong Wong, FRCP; Hui-Meng Chang, MRCP; Christopher Chen, FRCP; Jie Jin Wang, PhD; Michelle L. Baker, MBBS; Peter J. Hand, MRCP; Elena Rochtchina, MSc; Erica Yang Liu, BSc; Paul Mitchell, MD, PhD; Richard I. Lindley, FRACP Tien Yin Wong, FRCSE, PhD

From the Singapore General Hospital Campus (D.A.D., H.-M.C.), National Neuroscience Institute, Singapore; the Centre for Vision Research (G.L., J.J.W., E.R., P.M.), University of Sydney, Sydney, Australia; the National Medical Research Council (M.-C.W.), Singapore; the National University of Singapore (C.C.), Singapore; the Centre for Eye Research Australia (J.J.W., M.L.B., T.Y.W.), University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital (P.J.H.), Melbourne, Australia; Singapore Eye Research Institute (E.Y.L., T.Y.W.), Singapore; and the University of Sydney (R.I.L.), Sydney, Australia.

Correspondence to Deidre A. De Silva, MRCP, Department of Neurology, Singapore General Hospital, Outram Road, Singapore 169608. E-mail gnrdsd{at}sgh.com.sg

Background and Purpose— Previous studies show that both retinal vascular caliber and carotid disease predict incident stroke in the general population, but the exact relationship between these 2 microvascular and macrovascular structural risk factors is unclear. We studied the relationship between retinal vascular caliber and carotid disease in patients presenting with acute ischemic stroke.

Methods— We conducted a cross-sectional study of patients with acute ischemic stroke recruited from 3 centers (Melbourne, Sydney, Singapore). The caliber of retinal arterioles and venules was measured from digital retinal photographs. Severe extracranial carotid disease was defined as stenosis 75% or occlusion determined by carotid Doppler using North American Symptomatic Carotid Endarterectomy Trial-based criteria.

Results— Among the 1029 patients with acute stroke studied, 7% of the population had severe extracranial carotid disease. Retinal venular caliber was associated with ipsilateral severe carotid disease (P<0.001 in multivariate models). Patients with wider retinal venular caliber were more likely to have severe ipsilateral carotid disease (multivariable-adjusted OR, 3.81; 95% CI, 1.80 to 8.07, comparing the largest and smallest venular caliber quartiles). The retinal venular caliber–carotid disease association remained significant in patients with large artery stroke.

Conclusions— In patients with acute stroke, retinal venular widening was strongly associated with ipsilateral severe extracranial carotid disease. Our findings suggest concomitant retinal and cerebral microvascular disease may be present in patients with carotid stenosis or occlusion disease. The pathogenesis of stroke due to carotid disease may thus be partially mediated by microvascular disease.

Key Words: carotid disease • ischemic stroke • retinal vessel caliber