Carotid Artery Endarterectomy Effect on Choroidal Thickness: One-Year Follow-Up

Abstract

Purpose To evaluate the change in choroidal thickness after carotid artery endarterectomy (CEA) in patients without retinal pathology. Methods A prospective series of patients who underwent CEA at the Tel Aviv Medical Center. Spectral domain optical coherence tomography (SD-OCT) was performed one day before the CEA and at least 6 months after. Data included medical history, smoking history, percentage of carotid stenosis before and after CEA, best-corrected visual acuity (BCVA), central macular thickness (CMT), and choroidal thickness (subfoveal, 500 µm, 1000 µm, and 1500 µm nasal and temporal). Results Eight patients (seven male and one female) with a mean age of 70.5 ± 6.1 years were included in the study. The mean internal carotid artery (ICA) stenosis was 89.8% ± 5.1 in the operated side, 33.7% ± 10.9 in the nonoperated side (p < 0.0001), and 0% after CEA (p < 0.0001). Operated side BCVA was 0.35 ± 0.66 compared to 0.61 ± 0.83 in the nonoperated side (p=0.51). The mean subfoveal choroidal thickness (SFChT) of the operated side was 277 ± 67 µm compared to 268 ± 71 µm in the nonoperated side (p=0.81). SFChT and CMT after CEA were 275 ± 64 µm (p=0.96) and 268 ± 29 µm (p=0.98), respectively. Conclusions SFChT and CMT in patients without retinal or choroidal pathology and significant ICA stenosis can be normal and may not change after successful ipsilateral CEA.

Impact of Carotid Endarterectomy on Choroidal Thickness and Volume in Enhanced Depth Optical Coherence Tomography Imaging

“…In contrast, Rabina et al, based on a group of 8 patients with unilateral severe ICAS undergoing carotid endarterectomy, did not find any significant differences in SFCT between 6 and 14 months after surgery. e authors speculated that choroidal blood supplying the retina was sufficient despite the severe internal carotid stenosis in patients without ischaemic ocular syndrome signs due to preserved ophthalmic artery blood flow [27]. However, the study group was relatively small and predominantly male, and the participants were older.…”

“…However, the study group was relatively small and predominantly male, and the participants were older. Importantly, all of them were hypertensive, which could have potentially affected their results [27].…”

“…ere are few studies evaluating choroidal thickness measured with OCT in the context of carotid artery stenosis, and only two have assessed alterations in choroidal thickness after carotid endarterectomy. In addition, the conclusions from these two works do not overlap [27,28]. Both are based mainly on a single CT measurement in the subfoveal region that was performed manually by the authors.…”

Quantitative Optical Coherence Tomography Angiography Detects Retinal Perfusion Changes in Carotid Artery Stenosis

“…Regarding CT, there is controversial evidence in the literature too, with reports disclosing significant choroidal thinning or preserved CT ( Sayin et al, 2015 ; Rabina et al, 2018 ). In our study, CT resulted significantly lower in CAS eyes.…”

Subfoveal choroidal thickness in ipsi‐ and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy: a prospective study

“…The last study suggested that SFCT may perform well in choosing the optimal schedule for carotid surgery. Changes in SFCT before and after carotid endarterectomy (CEA) has been the topic of four small series (Lareyre et al 2018; Rabina et al 2018; Akca Bayar et al 2020; Krytkowska et al 2020), again with partly contradictory results and only one of these with control subjects (Akca Bayar et al 2020).…”