Abstract
BackgroundCarotid artery stenosis (CAS) is a multifaceted disease characterized by possible ocular involvement. Treatment with carotid endarterectomy helps to restore cerebral perfusion, which may prevent ocular and cerebral complications. The main aim was to assess retinal and choroidal vascular perfusion changes before and after endarterectomy in patients affected by CAS.MethodsThe design of the study was prospective and observational, including patients affected by CAS and healthy controls. The follow-up was 3 months. We performed quantitative optical coherence tomography (OCT) angiography (OCTA) analyses of retinal perfusion changes, before and after endarterectomy. The main outcome measures were the quantitative changes of choroidal thickness (CT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL); vessel density (VD); and vessel tortuosity (VT) OCTA metrics were also measured.ResultsSixty eyes of 30 patients affected by CAS and 30 eyes of 30 controls were included. We separately considered the ipsilateral eyes to CAS, the contralateral eyes to CAS, and the healthy eyes. Visual symptoms were absent in all the patients. RNFL and GCL resulted similar between patients and controls (p > 0.05). CT was significantly thinner in ipsilateral eyes than controls (p < 0.01), and it resulted unchanged after surgery (p > 0.05). VD resulted significantly altered only in some plexa of the ipsilateral eyes (p < 0.01), whereas VT disclosed decreased values of the entire retinal vascular network, both in ipsilateral and contralateral eyes (p < 0.05). Endarterectomy was followed by statistically significant improvement of retinal perfusion (p < 0.05).ConclusionOptical coherence tomography angiography can noninvasively detect postendarterectomy retinal perfusion improvements in CAS patients with baseline diabetes and hypertension as a systemic risk factor.
Highlights
Carotid artery stenosis (CAS) is a complex disease that can lead to a broad spectrum of neurological disorders such as ischemic stroke, transient ischemic attack, and vascular dementia (Grotta, 2013)
The main outcome measures were the quantitative changes of choroidal thickness (CT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL); vessel density (VD); and vessel tortuosity (VT) Optical coherence tomography angiography (OCTA) metrics were measured
CT was significantly thinner in ipsilateral eyes than controls (p < 0.01), and it resulted unchanged after surgery (p > 0.05)
Summary
Carotid artery stenosis (CAS) is a complex disease that can lead to a broad spectrum of neurological disorders such as ischemic stroke, transient ischemic attack, and vascular dementia (Grotta, 2013). Permanent occlusions, venous stasis retinopathy, and ocular ischemic syndrome might lead to severe visual impairment in patients affected by CAS (Cohen et al, 2010). Several imaging tests have been employed in the past years to evaluate the ocular changes associated with CAS. Fluorescein angiography has been reported as a useful investigation to detect microvascular changes associated with CAS, the invasive nature discourages its usage in patients without ocular symptoms (Choromokos et al, 1982; Sarkies et al, 1987; Terelak-Borys et al, 2012). Carotid artery stenosis (CAS) is a multifaceted disease characterized by possible ocular involvement.
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