Vascular Surgery Department, Galway University Hospital, Cairo, Egypt.
Vascular Surgery Department, Cairo University Hospital, Giza, Egypt.
Vascular. 2024 Aug;32(4):784-791. doi: 10.1177/17085381231163339. Epub 2023 Mar 13.
Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death..
To evaluate the association between the presence of asymptomatic cholesterol retinal emboli and the risk of cerebrovascular events, with assessment of the need for carotid intervention.
PubMed, Embase, and Cochrane Library databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines.
Initial search revealed 43 in Medline and 46 in Embase databases. Twenty-four potentially eligible studies were included after duplicate and non-related studies were excluded based on title and abstract. Three more studies were identified from reference lists. Seventeen studies were included in the final analysis. Asymptomatic cholesterol emboli were present in 1343 patients. Approximately 17.8% ( = 181) had history of either cerebro-vascular Accident (CVA) or transient ischaemic attacks (TIAs) at presentation (more than 6 months). Nine studies mentioned the incidence of cerebrovascular events during follow-up. Of 780 patients, 93 evolved to stroke, TIAs, or death from a major carotid event during the follow-up period (6-86 m), an incidence of about 12%. Death due to stroke was documented in 3 studies ( = 12).
The presence of asymptomatic retinal emboli indicates a risk of a cerebrovascular event when compared to patients with no plaques seen on fundoscopy. The evidence suggests that these patients warrant referral for medical optimization of cardiovascular risk factors. Currently, there is no recommendation to support carotid endarterectomy in patients with Hollenhorst plaques, or retinal emboli, and further studies are needed to assess this.
很少有研究评估眼底镜检查无症状胆固醇栓塞（称为 Hollenhorst 斑块）与随后发生中风或死亡的风险之间的关系。
评估无症状胆固醇视网膜栓塞的存在与脑血管事件风险之间的关联，并评估颈动脉干预的必要性。
使用适当的术语在 PubMed、Embase 和 Cochrane Library 数据库中进行搜索。系统评价按照 PRISMA 指南进行。
初步搜索显示 Medline 中有 43 项，Embase 中有 46 项。排除重复和不相关的研究后，根据标题和摘要，有 24 项潜在符合条件的研究被纳入。从参考文献中又确定了 3 项研究。最终分析纳入了 17 项研究。1343 例患者存在无症状胆固醇栓塞。约 17.8%（=181）在就诊时（超过 6 个月）有中风或短暂性脑缺血发作（TIA）病史。9 项研究提到了随访期间脑血管事件的发生率。在 780 例患者中，93 例在随访期间（6-86 个月）发生中风、TIA 或因颈动脉主要事件导致死亡，发生率约为 12%。3 项研究记录了中风导致的死亡（=12）。
与眼底镜检查未见斑块的患者相比，存在无症状视网膜栓塞表明发生脑血管事件的风险增加。证据表明，这些患者需要转诊进行心血管危险因素的医学优化。目前，尚无建议支持对 Hollenhorst 斑块或视网膜栓塞患者进行颈动脉内膜切除术，需要进一步研究来评估这一点。
