# Cardioembolism as a Mechanism of Central Retinal Artery Occlusion

> **NIH NIH K23** · DUKE UNIVERSITY · 2022 · $166,622

## Abstract

ABSTRACT
This is a K23 resubmission application for Dr. Brian Mac Grory, a vascular neurology investigator pursuing
patient-oriented clinical research focused on the identification of novel populations with underexplored
cerebrovascular disorders requiring personalized secondary prevention strategies. Based on his own
preliminary data and recent publications, the central hypothesis of this proposal is that central retinal artery
occlusion (CRAO) – a form of ischemic stroke affecting the retina – may be an indicator of underlying cardiac
disease and a sentinel of future, potentially lethal, cardioembolic stroke. CRAO is formally recognized as a
form of ischemic stroke but there is an incomplete understanding of its mechanistic underpinnings, with most
research to-date focused on its association with carotid artery stenosis. Testing this application’s central
hypothesis will address a fundamental knowledge gap about the mechanisms of CRAO. This K23 award
proposes to generate key preliminary data linking CRAO with cardioembolic substrates and set the stage for a
future, multi-center, observational study that will definitively test this hypothesis. Dr. Mac Grory will leverage a
very large population-based dataset (the Medicare 5% Sample) as well as both retrospective and prospective
institutional cohorts. Specific Aims 1A & 1B will determine the association of each of atrial fibrillation and left
ventricular failure with the development of CRAO. Specific Aims 2A & 2B will determine the association of
cardiac, serum and ultrasonographic biomarkers of embolic risk with CRAO and their interplay with carotid
artery stenosis. As part of this proposal, Dr. Mac Grory will undertake a linked, didactic training plan with the
goal of developing as an independent investigator through acquisition of the following key skills: 1) Biostatistics
in observational research including advanced causal inference methodology, 2) Data science applied to
administrative claims databases, 3) Prospective, observational study design, and 4) Vascular biomarker
interpretation. Advanced training in these areas will permit Dr. Mac Grory to realize his long-term career goal of
becoming an independent clinical investigator who leverages interdisciplinary expertise to provide insights in to
the management of understudied cerebrovascular disorders. In pursuit of this goal, Dr. Mac Grory has
assembled a mentoring team with distinct though complementary skillsets in stroke medicine, comparative
effectiveness research, causal inference methodology, cardiac electrophysiology, and neuro-ophthalmology.
Results supportive of this application’s central hypothesis would reveal a new population who may harbor
occult cardioembolic disease. Results that are neutral or negative with respect to this central hypothesis would
be equally valuable as they would allow us to refine the future study of CRAO by focusing on atherothrombotic
mechanisms. With the preliminary data and training obtained from the ...

## Key facts

- **NIH application ID:** 10525030
- **Project number:** 1K23HL161426-01A1
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Brian Mac Grory
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $166,622
- **Award type:** 1
- **Project period:** 2022-09-01 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10525030

## Citation

> US National Institutes of Health, RePORTER application 10525030, Cardioembolism as a Mechanism of Central Retinal Artery Occlusion (1K23HL161426-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10525030. Licensed CC0.

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