ABSTRACT NUMBER: ESOC2026A645 RISK OF RECURRENT STROKE IN PATIENTS WITH RETINAL ARTERY OCCLUSION CAUSED BY SYMPTOMATIC CAROTID STENOSIS

Abstract Background and aims For patients with symptomatic carotid stenosis, a retinal presenting event (retinal artery occlusion [RAO] or Amaurosis fugax [AFX]) is associated with lower risk of stroke pre- and postoperatively than cerebral presenting events (TIA or stroke). RAO often has clear embolic mechanism as a visible embolus on examination while AFX might have another mechanism. The few existing assessments that compared stroke risk between AFX and RAO have been underpowered. The aim of this study was to assess the risk of preoperative recurrent ipsilateral ischemic stroke or retinal artery occlusion (IISR) and perioperative risk between patients presenting with RAO, AFX, TIA and stroke. Methods We analyzed 927 patients with ≥50% symptomatic carotid stenosis derived from three cohorts. All participants were preliminary eligible for carotid revascularization. The risk of preoperative IISR and 30-day postoperative stroke/death was compared across presenting event types (RAO, AFX, TIA, stroke). Results Presenting events were: 141 (15%) AFX, 44 (5%) RAO, 306 (33%) TIA and 436 (47%) strokes. Compared to patients presenting with TIA and stroke, the 90-day risk of preoperative IISR was low and similar in the AFX and RAO groups (figure). The 30-day risk of perioperative stroke/death was lower for retinal events (1.4%, 2/148) than for cerebral events (5.8%, 29/503), P = 0.027, and similar for AFX (2.1%, 2/114) and RAO (0%, 0/34), P = 1.0. Conclusions RAO appears to have a similarly low risk of preoperative IISR and perioperative stroke or death as AFX. Thus, the mechanism of lower observed risks in patients with retinal events remains elusive. Conflict of interest Elias Johansson: Nothing to disclose. Sofia Strömberg: Nothing to disclose. Joakim Nordanstig: Nothing to disclose. Annika Nordanstig: Nothing to disclose. Figure 1 - belongs to Conclusions