Ocular findings as predictors of carotid artery occlusive disease: Is carotid imaging justified?

Heath K. McCullough, Carol G. Reinert, Linda S. Hynan, Christy L. Albiston, Mary H. Inman, Patty I. Boyd, M. Burress Welborn, G. Patrick Clagett, J. Gregory Modrall

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD. Methods Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings. Results Amaurosis fugax was associated with a positive scan in 20.0% of carotid arteries (P = .022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2% of carotid arteries (P = .02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6%) had significant ipsilateral internal carotid artery stenosis (P = .022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0%). Conclusions Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalJournal of Vascular Surgery
Volume40
Issue number2
DOIs
StatePublished - Aug 2004

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Carotid Artery Diseases
Amaurosis Fugax
Carotid Arteries
Retinal Artery Occlusion
Ischemic Optic Neuropathy
Carotid Stenosis
Neurologic Manifestations
Arteries
History

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Ocular findings as predictors of carotid artery occlusive disease : Is carotid imaging justified? / McCullough, Heath K.; Reinert, Carol G.; Hynan, Linda S.; Albiston, Christy L.; Inman, Mary H.; Boyd, Patty I.; Welborn, M. Burress; Clagett, G. Patrick; Modrall, J. Gregory.

In: Journal of Vascular Surgery, Vol. 40, No. 2, 08.2004, p. 279-286.

Research output: Contribution to journalArticle

McCullough, HK, Reinert, CG, Hynan, LS, Albiston, CL, Inman, MH, Boyd, PI, Welborn, MB, Clagett, GP & Modrall, JG 2004, 'Ocular findings as predictors of carotid artery occlusive disease: Is carotid imaging justified?', Journal of Vascular Surgery, vol. 40, no. 2, pp. 279-286. https://doi.org/10.1016/j.jvs.2004.05.004
McCullough, Heath K. ; Reinert, Carol G. ; Hynan, Linda S. ; Albiston, Christy L. ; Inman, Mary H. ; Boyd, Patty I. ; Welborn, M. Burress ; Clagett, G. Patrick ; Modrall, J. Gregory. / Ocular findings as predictors of carotid artery occlusive disease : Is carotid imaging justified?. In: Journal of Vascular Surgery. 2004 ; Vol. 40, No. 2. pp. 279-286.
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abstract = "Objectives Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD. Methods Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings. Results Amaurosis fugax was associated with a positive scan in 20.0{\%} of carotid arteries (P = .022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2{\%} of carotid arteries (P = .02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6{\%}) had significant ipsilateral internal carotid artery stenosis (P = .022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0{\%}). Conclusions Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.",
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T2 - Is carotid imaging justified?

AU - McCullough, Heath K.

AU - Reinert, Carol G.

AU - Hynan, Linda S.

AU - Albiston, Christy L.

AU - Inman, Mary H.

AU - Boyd, Patty I.

AU - Welborn, M. Burress

AU - Clagett, G. Patrick

AU - Modrall, J. Gregory

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N2 - Objectives Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD. Methods Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings. Results Amaurosis fugax was associated with a positive scan in 20.0% of carotid arteries (P = .022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2% of carotid arteries (P = .02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6%) had significant ipsilateral internal carotid artery stenosis (P = .022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0%). Conclusions Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.

AB - Objectives Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD. Methods Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings. Results Amaurosis fugax was associated with a positive scan in 20.0% of carotid arteries (P = .022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2% of carotid arteries (P = .02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6%) had significant ipsilateral internal carotid artery stenosis (P = .022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0%). Conclusions Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.

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