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A.P. Swan, C.L. Hagedorn, T.L. Lucas, R.A. Adelman; Fluorescein Angiography as an Indicator of Stroke Risk: Correlation of Arm–Retina Time and Carotid Artery Stenosis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4056.
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Purpose: It is commonly accepted that internal carotid artery stenosis is one of several factors that influences arm–retina time in fluorescein angiography. However, there is inadequate data to indicate what level of delayed filling, if any, should prompt the ophthalmologist to recommend a cerebral vascular work up. This study examines the correlation between the arm–retina time obtained from patients undergoing fluorescein angiography with the incidence of significant carotid artery stenosis. Methods: In this retrospective study, we reviewed the charts of patients that underwent fluorescein angiography at the Yale Eye Center from 1998 to 2004. Patients with slow injection times or injection sites other than the antecubital fossa were excluded. Further identifying those patients who underwent carotid doppler imaging, we examined the arm–retina time, defined as the length of time between the initiation of injection to the first indication of fluorescence within the central retinal artery. Results: Of the 11 patients with available carotid doppler studies, the mean arm–retina time of patients with significant carotid artery stenosis (greater than 50%) was significantly higher than those patients with absent or insignificant stenosis (24.90 seconds verses 19.14 seconds, p = 0.0286). Conclusions: Current literature shows that patients with increasing degrees of stenosis clearly demonstrate an increase in the risk of stroke, myocardial infarction, and death. Nevertheless, the utility of screening the general population for asymptomatic stenosis remains controversial and problematic. Our results suggest a direct relation between the duration of arm–retina time on fluorescein angiography and the likelihood of significant carotid artery stenosis. Therefore, fluorescein angiography offers a promising ancillary role as an identifier of patients who are at particularly high risk of stenosis. Further evaluation of arm–retina time could serve to establish guidelines for initiating a cerebral vascular and cardiovascular work up.
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