Retinal Microvascular Changes Differentiate Mild Stroke and Transient Ischemic Attack (TIA) from Mimics among Patients Presenting to the Emergency Department (ED) with Suspected TIA: The FOTO-TIA Study (2266)

Objective: A primary aim of the FOTO-TIA study was to investigate a possible role for retinal microvascular findings in TIA risk stratification. Background: About 10% of the 250–500,000 Americans who experience TIA annually have a stroke within 90 days. Clinical scores and MRI-DWI findings are routinely used to help triage patients with suspected TIA, although categorizing DWI-negative spells as TIAs or non–cerebrovascular events (CVE) is challenging. Design/Methods: FOTO-TIA was a cohort study of adult patients with a NIH Stroke Scale ≤ 3 admitted to three EDs’ observation units for an accelerated diagnostic protocol for suspected TIA or stroke. Clinical and imaging results were recorded prospectively. Non-mydriatic fundus photographs were obtained as part of the accelerated diagnostic protocol and reviewed for retinal microvascular findings, defined as retinal hemorrhages, cotton wool spots, retinal emboli or occlusions, hard exudates, or microaneurysms. A neurologist rated the probability each patient’s presentation (masked to fundus photography) represented a CVE on a visual analogue scale. Results: 395 patients were enrolled (median age: 57 years (interquartile range [IQR]: 50–66); 219 (55%) women; 253 (64%) black; 34 (9%) retinal microvascular findings present; median CVE probability assessment 22% (IQR: 5–100)). Controlling for the individual components of the ABCD2 score (age, systolic and diastolic blood pressure, clinical symptoms, duration of symptoms, and diabetes) and presence of a MRI-DWI positive lesion, any retinal microvascular finding increased the CVE probability assessment by 15.6% (95%CI: 4.2–27.1%, p=0.008). Excluding patients with a DWI positive lesion (i.e., those with definite stroke), any retinal microvascular finding increased CVE probability assessment by 21.8% (95%CI: 6.1–37.5%, p=0.007). Conclusions: Retinal microvascular findings assessed by nonmydriatic ocular fundus photographs during the evaluation of suspected TIAs in the ED are an independent factor differentiating TIA and stroke from mimics. Disclosure: Dr. Bruce has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with MedImmune, Bayer, Jensen Law Group. Dr. Bidot has nothing to disclose. Dr. Nahab has nothing to disclose. Dr. Siegelman has nothing to disclose. Dr. Bianchi has nothing to disclose. Dr. Sandor has nothing to disclose. Dr. Lin has nothing to disclose. Dr. Bell has nothing to disclose. Dr. Ross has nothing to disclose. Dr. Wright has nothing to disclose. Dr. Biousse has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Gensight Biologics.Dr. Newman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with GenSight, Santhera, and Quark. Dr. Newman has received research support from GenSight and Santhera.