EVALUATION OF RETINAL CAPILLARY DENSITY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ACCORDING TO ACUTE ISCHEMIC STROKE ETIOLOGIES: A Matched Case-Control Study Stroke and Retinal Capillary Density.

PURPOSE

To investigate retinal microvascular changes in ischemic stroke patients using optical coherence tomography angiography (OCT-A) and assess these alterations based on stroke etiology.

METHODS

Case-control study conducted at Montpellier University Hospital from May 2021 to March 2022 (Institutional Review Board: 202000607). Retinal vascular features were compared between strokes patients and age-matched and sex-matched controls. Optical coherence tomography angiography was performed using RTVue-XR-Avanti with AngioVue (Optovue). Multivariate mixed-effects analysis of covariance models adjusted for age, sex, intraocular pressure, and cardiovascular risk factors were used.

RESULTS

Ninety-two eyes were included: 21 with micro-/macroangiopathy stroke, 12 with etiologically ambiguous stroke, 13 with cardioembolic stroke, and 46 eyes from control subjects. After adjusting for age, sex, and intraocular pressure, stroke patients had significantly lower parafoveal superficial capillary plexus vessel density ( P = 0.013) and superficial capillary plexus flow index ( P = 0.023) compared with control subjects, especially in the macro-/microangiopathy subgroup. When cardiovascular risk factors were included, only the superficial capillary plexus flow index difference remained significant ( P = 0.023). Optical coherence tomography angiography's diagnostic accuracy was validated with an area under the receiver operating characteristic curve of 0.83.

CONCLUSION

Optical coherence tomography angiography effectively detects retinal microvascular alterations in stroke patients, with persistent alterations in macro-/microangiopathy strokes after adjusting for cardiovascular risk factors. These findings support OCT-A's role in stroke subtype classification.