The Impact of Carotid Endarterectomy on Choriocapillaris Perfusion.

Abstract

The impact of carotid endarterectomy (CEA) on choriocapillaris (CC) perfusion was investigated using swept-source optical coherence tomography angiography (SS-OCTA) imaging before and after surgery in patients with clinically significant carotid artery stenosis (CAS). In this prospective observational study, patients with clinically significant CAS undergoing unilateral CEA had SS-OCTA imaging performed in both eyes before and within 1 week after surgery. The percent CC flow deficits (CC FD%) and CC thickness were assessed using previously validated algorithms. Multivariable regression analysis was conducted to evaluate the impact of variables on the change in CC measurements. A total of 112 eyes from 56 patients with an average age of 72.6 ± 6.9 years were enrolled. At baseline, significantly higher CC FD% and thinner CC thickness were observed on the surgical side (eyes ipsilateral to the side of CEA) versus the nonsurgical side (eyes contralateral to the side of CEA) (P=0.001 and P=0.03, respectively). Following CEA, a significant reduction in CC FD% and a significant increase in CC thickness were detected on the surgical as compared with the nonsurgical side (P=0.008 and P=0.01, respectively). Smoking status positively affected CC FD% change (coefficient of variation [CV]=0.84, P=0.01) on the surgical side and negatively affected CC thickness change on both the surgical side (CV=-0.382, P=0.009) and the nonsurgical side (CV=-0.321, P=0.04). The degree of stenosis demonstrated a positive influence on CC FD% change (CV=0.040, P=0.02) on the surgical side. Unilateral CEA on the side of clinically significant CAS increases carotid blood flow, which further results in improved CC perfusion.