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transthoracic echocardiography, and
transesophageal echocardiography. 6
Carotid ultrasonography in patients with
Hollenhorst plaques is important, regardless
of symptoms, because it may detect carotid
stenosis, which may be surgically correctable. It
11
may also detect atherosclerosis, which may be
an independent marker for future stroke. Both
11
carotid stenosis and atherosclerosis can increase
mortality. If a patient has not had a stroke
or a transient ischemic attack (TIA), carotid
endarterectomy is generally helpful to reduce
overall brain stroke risk when carotid artery
narrowing is 70% or greater. If the patient has
12
suffered a stroke or TIA, carotid endarterectomy MULTIPLE ARTERY
may be helpful if the carotid artery stenosis is PLAQUES W ARROWS
over 50%. Otherwise, the focus should be on
12
lifestyle and risk factor modification in those 4. Leavitt JA, Larson TA, Hodge DO, et al. The
incidence of central retinal artery occlusion in
patients with less than surgically correctable Olmstead county, Minnesota. Am J Ophthamol
disease. There are no specific guidelines 2011;152:820-3.
13
regarding the treatment of retinal emboli. The 5. Chang YS, Jan RL, Weng SF, et al. Retinal artery
therapeutic goal is to increase retinal perfusion occlusion and the 3-year risk of stroke in Taiwan:
pressure and/or dislodge the embolus. A nationwide population-based study. Am J
8
Ophthalmol 2012;154:645-52.
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2. Majstruk L, Giocanti-Aurégan A. Multimodal
imaging of a Hollenhorst plaque. J Fr Ophthalmol 7. Mac Grory, B., Schrag, M., Biousse, V., et al, &
2016;39(7):655-6. American Heart Association Stroke Council.
Management of central retinal artery occlusion:
3. Tokoyoda T, Tsujimoto I, Sugiura Y, Sezaki R. A A scientific statement from the American Heart
Hollenhorst plaque in cholesterol crystal embolism. Association. Stroke 2021;52:282–94.
Intern Med 2012;51:223.
8. Keith JF. Arterial occlusive disease in Onofrey BE,
Skorin L, Holdeman NR (eds). Ocular Therapeutics
Handbook: A Clinical Manual (4 Ed.) Wolters
th
Kluwer. Philadelphia 2020:533-6.
9. Chen CS, Varma D, Lee A. Arterial occlusions to
the eye: from retinal emboli to ocular ischemic
syndrome. Asia Pac J Ophthalmol 2020;9:349-57.
10. Lavin, P., Patrylo, M., Hollar, M., et al. Stroke risk and
risk factors in patients with central retinal artery
occlusion. Am J Ophthalmol 2018;196:96–100.
11. Bakri SJ, Luqman A, Pathik B, Chandrasekaran K.
Is carotid ultrasound necessary in the evaluation
of the asymptomatic Hollenhorst plaque?
Ophthamol 2013;120:2747-8.
12. Stauffer R. Carotid endarterectomy and stenosis.
Retrieved from https://www.aans.org.
MULTIPLE HOLLENHORST
PLAQUES W ARROWS 13. Hayreh SS. Central retinal artery occlusion. Indian J
Ophthalmol 2018;66:1684-94.
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