Reversed ophthalmic artery flow following ischemic stroke: a possible predictor of outcomes following carotid artery stenting

ABSTRACT

Stroke is the leading cause of death worldwide and stenosis of the carotid artery accounts for more than half of all cases. Carotid duplex is an effective non-invasive ultrasound test which identifies stroke patients with moderate to severe carotid stenosis who are candidates for preventative intervention to reduce the risk of recurrence.

In patients with moderate to severe carotid stenosis, reversed ophthalmic artery flow (ROAF) is often observed at the time of the carotid duplex scan. In this study, we investigated whether ROAF, denoting exhaustion of cerebral collateral flow in ischemic stroke patients affected mid-term functional outcomes following carotid artery stenting (CAS) procedures.

In total, 144 consecutive patients with a first episode of ischemic stroke and subsequent CAS procedure conducted between January 2010 and November 2014 at Changhua Christian Hospital, Taiwan were included. Clinical data were obtained by medical record review. Disability was assessed at two time points by utilising the Barthel Index (BI) and modified Rankin Scale (mRS) before CAS and 12 months post-CAS.

Among 85 patients presenting without ROAF, 48/85 (56.4%) had improved mRS scores following stenting. The condition remained unchanged (stationary) in 36/85 (43.5%) patients after stenting and one patient exhibited deteriorated condition 1/85(1.1%).

In contrast, among the 59 patients presenting with ROAF, 24/59 (40.6%) had improved mRS score following stenting. The condition remained unchanged (stationary) in the remaining 35/59 (59.3%) patients after stenting, and no patient exhibited deteriorated condition 0/59 (0 %).

This study provides evidence that CAS is a valid and effective treatment option regardless of whether patients exhibited ROAF or not. Patients without ROAF were significantly more likely to have improved mid-term functional outcomes compared to those with ROAF. In the group without ROAF admission, CRP may play a role in predicting subsequent functional outcomes, whereas admission Barthel Index was a predictor of outcome in the ROAF group.

KEYWORDS:

• Ischemic stroke
• ophthalmic artery
• modified Rankin scale
• Barthel Index
• C-reactive protein
• carotid duplex

Acknowledgments

With special thanks to Ping-Yi Lin, PHD of Changhua Christian Hospital for her constructive comments.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplementary data for this article mcan be accessed here.

Additional information

Funding

This project is partially supported by Ministry of Science and Technology and Big Data Research Center of National Chiao Tung University, Taiwan.

Notes on contributors

Chih-Ming Lin

Chih-Ming Lin, MD, MPH, PHD: collecting data and study design

Chi-Kuang Liu

Chi-Kuang Liu, MD: data collection

Yu-Jun Chang

Yu-Jun Chang, PHD: bio-statistical analysis

Wei-Liang Chen

Wei-Liang Chen, MD: data analysis

Henry Horng-Shing Lu

Henry Horng-Shing Lu, PHD: study design and data analysis