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3 . 2026

Acute ocular ischemia as a factor in the development of acute cerebrovascular events in patients with carotid atherosclerosis

Abstract

Background. Ocular ischemia is regarded as a clinical marker of an atherosclerotic lesion of brachiocephalic arteries and neurological deficit. The best-known manifestations include amaurosis fugax, occlusion of the central retinal artery and its branches, as well as acute ischemic optic neuropathy. Amaurosis fugax is defined as a form of transient ischemic attack, thus making it possible to consider these patients symptomatic and candidates for surgical treatment.

Objective. To assess the clinical significance of acute ocular ischemia (AOI) as a prognostic factor for ischemic stroke.

Patients and methods. This prospective cohort study included 102 patients with internal carotid artery (ICA) stenosis ≥70% and clinical manifestations of AOI (amaurosis fugax, occlusion of the central retinal artery and its branches, anterior ischemic optic neuropathy). The patients were divided into two groups: surgical treatment (carotid endarterectomy, n=50) and conservative therapy (n=52). Changes in visual function (visual acuity, visual fields, optic nerve function) and neurological outcomes were assessed at 1 month and 1 year of follow-up.

Results. In the surgical group, a statistically significant improvement in visual acuity was observed at 1 month and 1 year (p<0.001), along with a higher rate of improvement in visual fields (44.9% vs 8%) and optic nerve function (46.9% vs 8.0%) compared to conservative therapy (p<0.01). The likelihood of visual function improvement after surgery was significantly higher (OR up to 10.17). Patients after carotid endarterectomy demonstrated regression of neurological symptoms, including complete resolution of amaurosis fugax episodes. In contrast, the conservative treatment group showed progression of cerebrovascular insufficiency with an increased incidence of transient ischemic attacks and ischemic stroke.

Conclusion. Acute ocular ischemia represents a clinical equivalent of cerebrovascular ischemia and is a significant predictor of ischemic stroke. In patients with AOI and hemodynamically significant ICA stenosis, surgical treatment provides significant improvement in visual function and reduces the risk of cerebrovascular complications. These patients should be considered symptomatic and candidates for surgical treatment.

Keywords:acute ocular ischemia; amaurosis fugax; internal carotid artery stenosis; carotid endarterectomy; ischemic stroke; ocular ischemic syndrome

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Gavrilenko A.V., Kuklin A.V., Kiseleva T.N.; data collection and handling, statistical processing, draft manuscript preparation – Kiseleva T.N., Kuklin A.V., Zobov K.I., Kravchenko A.A.; manuscript revision – Kuklin A.V.

For citation: Gavrilenko A.V., Kuklin A.V., Kiseleva T.N., Zobov K.I., Kravchenko A.A. Acute ocular ischemia as a factor in the development of acute cerebrovascular events in patients with carotid atherosclerosis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 64–70. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-64-70

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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