Retinal Microvascular Changes in Subtypes of Ischemic Stroke

Ying Zhao; Bing Yang; An-Ding Xu; Yi-Wen Ruan; Ying Xu; Hui-Ling Hu; Ze-Feng Tan

doi:10.3389/fneur.2020.619554

Retinal Microvascular Changes in Subtypes of Ischemic Stroke

Front Neurol. 2021 Jan 27:11:619554. doi: 10.3389/fneur.2020.619554. eCollection 2020.

Authors

Ying Zhao^{1

2}, Bing Yang^{1

2}, An-Ding Xu^{1

2}, Yi-Wen Ruan³, Ying Xu³, Hui-Ling Hu⁴, Ze-Feng Tan^{1

2

5}

Affiliations

¹ Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
² Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China.
³ Department of Central Nervous System Regeneration, Guangdong-Hongkong-Macau Institute of Central Nervous System (CNS) Regeneration (GHMICR), Jinan University, Guangzhou, China.
⁴ Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Shenzhen University School of Medicine, Shenzhen, China.
⁵ Department of Neurology, The Affiliated Shunde Hospital of Jinan University, Guangzhou, China.

Abstract

Aims: Retinal microvasculature shares prominent similarities with the brain vasculature. We aimed to assess the association between retinal microvasculature and subtypes of ischemic stroke. Method: We consecutively enrolled ischemic stroke patients within 7 days of onset, who met the criteria of subtype of atherothrombosis (AT), small artery disease (SAD), or cardioembolism (CE) according to a modified version of the Trial of Org 10172 in Acute Stroke Treatment (NEW-TOAST). Digital fundus photographs were taken within 72 h of hospital admission using a digital camera (Topcon TRC-50DX), and fundus photographs were semi-automatically measured by software (Canvus 14 and NeuroLucida) for retinal vasculature parameters. Results: A total of 141 patients were enrolled, including 72 with AT, 54 with SAD, and 15 with CE. AT subtype patients had the widest mean venular diameter within 0.5-1.0 disk diameter (MVD_0.5-1.0DD) followed by SAD and CE subtypes (86.37 ± 13.49 vs. 83.55 ± 11.54 vs. 77.90 ± 8.50, respectively, P = 0.047); CE subtype patients had the highest mean arteriovenous ratio within 0.5-1.0 disk diameter (MAVR_0.5-1.0DD) followed by the AT and SAD subtype groups (0.97 ± 0.03 vs. 0.89 ± 0.99 vs. 0.89 ± 0.11, respectively, P = 0.010); SAD subtype patients were found with the highest mean venular tortuosity within 0.0-2.0 disk diameter (MVT_0.0-2.0DD) followed by the AT and CE subtypes (1.0294 ± 0.0081 vs. 1.0259 ± 0.0084 vs. 1.0243 ± 0.0066, respectively, P = 0.024). After adjusting for clinic characteristics, MVD_0.5-1.0DD was significantly different among AT, SAD, and CE subtypes (P = 0.033). By receiver operating characteristic curve analysis, MVD_0.5-1.0DD predicted the AT subtype (area 0.690, 95% confidence interval, 0.566-0.815), with a cutoff value of 82.23 μm (sensitivity 61.1%, specificity 73.3%). Conclusion: Retinal MVD_0.5-1.0DD (>82.23 μm) might be associated with the AT stroke subtype; however, we need large-scale prospective studies in future to explore the underlying mechanism and causal explanation for this finding.

Keywords: ischemic stroke; neurolucida; retinal microvascular changes; subtypes; venular diameter.