Mayo Clinic Proceedings Home

Stroke Risk Before and After Central Retinal Artery Occlusion in a US Cohort



      To determine the risk of ischemic stroke, transient ischemic attack (TIA), and amaurosis fugax around the time of central retinal artery occlusion (CRAO).

      Patients and Methods

      Patients at Mayo Clinic sites with a diagnosis code of CRAO from January 1, 2001, through September 9, 2016, were reviewed. New CRAOs were confirmed, and ischemic stroke, TIA, and amaurosis fugax events were tallied within 15 days before and after CRAO.


      Three hundred patients with CRAO were included in the study cohort. The median age at the time of CRAO was 72 years (range, 19-100 years), and 158 (53%) were male patients. Overall, 16 patients (5.3%) had symptomatic ischemic stroke around the time of CRAO, with 7 strokes (2.3%) occurring 15 days before CRAO, 4 (1.3%) occurring simultaneously with CRAO, and 5 (1.7%) occurring after CRAO. Transient ischemic attack and amaurosis fugax were seen in 5 (1.7%) and 26 (8.7%) patients, respectively. It was found that 7% (9/128) of patients with embolic CRAO had a stroke around the time of CRAO as compared with 1.3% (2/149) of patients with an unknown cause of CRAO.


      Symptomatic stroke, TIA, or amaurosis fugax is common around the time of CRAO. Therefore, CRAOs require urgent embolic work-ups.

      Abbreviations and Acronyms:

      CRAO (central retinal artery occlusion), CRVO (central retinal vein occlusion), MRI (magnetic resonance imaging), RAO (retinal artery occlusion), TIA (transient ischemic attack)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Leavitt J.A.
        • Larson T.A.
        • Hodge D.O.
        • Gullerud R.E.
        The incidence of central retinal artery occlusion in Olmsted County, Minnesota.
        Am J Ophthalmol. 2011; 152: 820-823.e822
        • Hayreh S.S.
        • Zimmerman M.B.
        Central retinal artery occlusion: visual outcome.
        Am J Ophthalmol. 2005; 140: 376-391
        • Chang Y.S.
        • Jan R.L.
        • Weng S.F.
        • et al.
        Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study.
        Am J Ophthalmol. 2012; 154: 645-652.e651
        • Park S.J.
        • Choi N.K.
        • Yang B.R.
        • et al.
        Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion.
        Ophthalmology. 2015; 122: 2336-2343.e2342
        • Stuart A.
        CRAO: harbinger of ischemic stroke. EyeNet Magazine. June 2016.
        • Olsen T.W.
        • Pulido J.S.
        • Folk J.C.
        • Hyman L.
        • Flaxel C.J.
        • Adelman R.A.
        Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®.
        Ophthalmology. 2017; 124: P120-P143
        • Brown R.D.
        • Whisnant J.P.
        • Sicks J.D.
        • O’Fallon W.M.
        • Wiebers D.O.
        Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989.
        Stroke. 1996; 27: 373-380
        • Hayreh S.S.
        • Zimmerman M.B.
        Ocular arterial occlusive disorders and carotid artery disease.
        Ophthalmol Retina. 2017; 1: 12-18
        • Gage B.F.
        • Waterman A.D.
        • Shannon W.
        • Boechler M.
        • Rich M.W.
        • Radford M.J.
        Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.
        JAMA. 2001; 285: 2864-2870
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.J.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.
        Chest. 2010; 137: 263-272
        • Lee J.
        • Kim S.W.
        • Lee S.C.
        • Kwon O.W.
        • Kim Y.D.
        • Byeon S.H.
        Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study.
        Am J Ophthalmol. 2014; 157: 1231-1238
        • Helenius J.
        • Arsava E.M.
        • Goldstein J.N.
        • et al.
        Concurrent acute brain infarcts in patients with monocular visual loss.
        Ann Neurol. 2012; 72: 286-293
        • Lauda F.
        • Neugebauer H.
        • Reiber L.
        • Jüttler E.
        Acute silent brain infarction in monocular visual loss of ischemic origin.
        Cerebrovasc Dis. 2015; 40: 151-156

      Linked Article

      • Retinal Occlusion, Ischemic Stroke, and the Brain-Eye Connection
        Mayo Clinic ProceedingsVol. 94Issue 2
        • Preview
          The risk of cerebral infarction associated with retinal ischemia has been the subject of an evolving debate. Several factors complicate this association, including varied types of ischemic visual events ranging from transient monocular visual loss to anterior ischemic optic neuropathy and retinal artery occlusion (branch or central); additionally, diagnostic and therapeutic options for cerebral ischemia continue to advance.
        • Full-Text
        • PDF