Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.

Relationship of Vessel Density to Vessel Length Density in Patients with Treated Fabry Disease

“…Previous publications demonstrated that OCTA is able to detect alterations in the retinal microvasculature and could potentially be useful as an early diagnostic biomarker and for the follow-up examinations of patients affected by different systemic diseases [ 28 , 30 , 38 , 40 , 44 , 45 ]. In general, VD and VLD are OCTA biomarkers that have been used to assess the retinal microvasculature in different retinal and systemic diseases for years [ 24 , 28 , 29 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. While numerous findings on differences in VD and/or VLD in multiple diseases have been reported this study is the first to report on a statistically significant difference between an affected population (our FD cohort) and an HC group in VD/VLD ratio in DCP.…”

Optical coherence tomography angiography as a surrogate marker for end-organ resuscitation in sepsis: A review

“…In addition to reporting retinal blood flow alterations in systemic disease ( 29 , 30 , 33 – 35 ), Kannenkeril et al also indicate that OCTA changes are associated with disease progression in CKD ( 31 ), showing promise as a marker of disease severity in other systemic disorders affecting the microcirculation. Coppolino et al ( 32 ) found an association between pre-dialysis retinal VD and patients who subsequently experienced intradialytic hypotension, demonstrating prognostic value and concluding that OCTA could stratify the short-term risk of this complication.…”

“…After transcatheter aortic valve implantation, OCTA scans found new retinal capillary dropout in 28.6% of participants in both the superficial and deep capillary plexi ( 33 ), while vessel density and FAZ size remained stable between pre- and post-implantation scans, with authors suggesting lesions were too small to have significant overall blood flow effects ( 33 ).…”

Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls

“…In line with the current literature, the output value of the vessel density (VD) was used for OCTA analysis [ 28 , 30 , 31 , 32 , 33 , 34 ]. Additional data, including sex, age on the date of examination, and COVID-19 exposure, were recorded.…”