Contrast-enhanced carotid ultrasound improves vulnerable plaque detection in acute central retinal artery occlusion: a propensity score-matched study.

BACKGROUND

Central retinal artery occlusion (CRAO) is an ophthalmic emergency that signals a markedly increased risk of ischemic stroke and systemic vascular events. Contrast-enhanced ultrasound (CEUS) offers advanced imaging of carotid plaque vulnerability, but its diagnostic utility in CRAO remains inadequately explored.

OBJECTIVE

To evaluate the diagnostic value of CEUS in identifying vulnerable carotid plaques in patients with acute CRAO.

METHODS

In this retrospective, propensity score-matched study, 110 patients with acute CRAO and 110 matched healthy controls were enrolled. Matching was performed for age, sex, and key cardiovascular risk factors. All participants underwent standardized carotid duplex ultrasound and CEUS, with plaque vulnerability assessed by intraplaque neovascularization grading. Logistic regression was used to identify independent predictors of CRAO. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Compared to controls, CRAO patients had a significantly higher prevalence of vulnerable carotid plaques (CEUS enhancement scores ≥2: 85.5% vs. 21.8%, p < 0.001). Key ultrasound predictors of CRAO included increased intima-media thickness, plaque length, higher peak systolic velocity, resistance index, pulsatility index, and CEUS enhancement score. The combined diagnostic model, integrating both conventional and CEUS parameters, demonstrated superior accuracy (AUC = 0.916) compared to conventional ultrasound (AUC = 0.738) or CEUS alone (AUC = 0.754).

CONCLUSIONS

CEUS significantly improves the detection of vulnerable carotid plaques in patients with acute CRAO and, when combined with conventional ultrasound, markedly enhances diagnostic performance. Incorporating CEUS into routine vascular assessment may facilitate better risk stratification and inform personalized secondary prevention strategies for CRAO patients.