PC068. Carotid Intervention Compared With Medical Management Decreases Stroke and Mortality in Patients with Amaurosis Fugax or Retinal Artery Occlusion

Abstract

Amaurosis fugax (AF) is a risk factor for carotid stenosis and subsequent ischemic stroke. However, this risk differs from that of patients who experience transient ischemic attacks involving the cerebral hemisphere. Retinal artery occlusion (RAO) is another common ocular phenomenon that does not always cause AF. It remains unknown whether asymptomatic RAO without AF also increases the risk of stroke. Few studies have compared the outcomes of medical management vs carotid intervention in this specific population of patients with AF/RAO and carotid stenosis. We hypothesize that patients with AF/RAO and carotid stenosis who receive either carotid endarterectomy (CEA) or carotid artery stenting (CAS) will exhibit decreased subsequent stroke. The Healthcare Cost and Utilization Project State Inpatient Database from Florida between 2006 and 2015 was queried using International Classification of Diseases, Ninth Revision codes. Patients were stratified into two cohorts: conservative management and intervention. The intervention group was further subdivided into CEA and CAS. Outcome variables included mortality and stroke. Univariate analysis was conducted using t-testing for continuous variables and χ2 tests for categorical variables. Multivariate logistic regression was used to analyze 6-month mortality and stroke risk after initial RAO or AF diagnosis. A total of 9121 patients with AF or RAO were identified, and 2594 procedures were completed (2242 CEAs and 352 CAS procedures). Average age was 68.5 years. Male sex (65.2% vs 52.3%; P < .001) and white race (90.4% vs 77.1%; P < .001) were significantly more common in the surgical cohort than in the medical cohort. Multivariate regression analysis was then used to adjust for these disparate demographic data between cohorts. We found that patients with AF/RAO who underwent CEA or CAS demonstrated a 24% decreased risk of mortality (P < .001) and 31% decreased risk of stroke (P < .001) within 6 months of initial AF/RAO diagnosis compared with patients with medical management. Subgroup analysis further revealed that in patients with only RAO (without AF) who underwent CEA or CAS, there is a 63% decreased risk of mortality (P = .247) and 13% decreased risk of stroke (P = .001) compared with patients with medical management. Similarly, in patients with AF without RAO who underwent carotid intervention, there is a 46% decreased risk of mortality (P < .002) and 29% decreased risk of stroke (P < .001). Patients with either AF or RAO exhibit decreased mortality and stroke after carotid intervention (CEA or CAS) compared with those who are medically managed.