Abstract
Purpose Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion. Methods In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t-test was used to evaluate the preoperative and postoperative changes in OCTA variables. Results The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161; SVC: 48.65 vs. 52.22, P = 0.0006; DVC: 49.65 vs. 57.50, P < 0.0001). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001; SVC, P = 0.0104; DVC, P = 0.0104). Moreover, the ocular perfusion was consistent with that established by CTP. Conclusion OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.
Highlights
Carotid artery stenosis (CAS) is one of the major causes of cerebral ischemic stroke, and its early detection is of considerable significance for stroke prevention [1, 2]
The results showed that the contralateral carotid artery had no stenosis in patients with severe unilateral carotid artery stenosis and occlusion, the blood supply of the contralateral eyes was reduced, and the superficial retinal vascular complexes (SVC) and deep vascular complexes (DVC) vessel densities were significantly lower than those of the control eyes, with statistically significant differences (P = 0:0123; 0.0007, Table 2)
We found that patients with poor cerebral perfusion caused by severe carotid artery stenosis or occlusion had poorer retinal vessel density than patients with moderate carotid artery stenosis (Figure 5)
Summary
Carotid artery stenosis (CAS) is one of the major causes of cerebral ischemic stroke, and its early detection is of considerable significance for stroke prevention [1, 2]. Due to the high CAS-inflicted disability rates and the great economic burden imposed on society, screening for abnormalities preceding the occurrence of such severe complications is of critical global importance. Due to its high price and radiation risk, this approach cannot be used for large-scale early screening of cerebral ischemia. CT perfusion imaging (CTP) is commonly used in the clinic. Most carotid artery stenosis patients are unable to tolerate CTP because of their poor systemic vascular condition. A simple, noninvasive, and inexpensive screening tool for carotid artery stenosis is crucial
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