Changes in Ocular Hemodynamics after Carotid Artery Angioplasty and Stenting (CAAS) in Patients with Different Severity of Ocular Ischemic Syndrome

BackgroundTo evaluate choroidal vascularity index (CVI) in eyes with internal carotid artery (ICA) stenosis using binarization tool in enhanced depth images scanned by spectral domain optical coherence tomography.MethodsA retrospective cohort study was conducted in 142 patients with ICA stenosis, and 20 normal control subjects matched with the age, sex, etc. According to the diagnostic criteria, the participants are divided into a normal control group (20 cases), a mild stenosis group (64 cases), a moderate stenosis group (61 cases), and a severe stenosis group (17 cases). Enhanced depth imaging optical coherence tomography (EDIOCT) was performed to scan macular fovea, which was separated into a luminal area and a stromal area using image binarization. The choroidal vascularity index (CVI) is luminal area divided by total choroidal area.ResultsThere was no statistical difference in age or sex among groups. Subfoveal choroidal thickness (SFCT) in the severe stenosis group was significantly lower than that in the normal group (P < 0.05). Moreover, the CVI in moderate stenosis group and severe stenosis group were significantly lower compared with the normal control group (P < 0.001). When CVI = 65.16% was set as the cut-off value, all 162 subjects could be divided into two groups, CVI ≤ 65.16 (n = 83) and CVI > 65.16% (n = 79). The proportions of mild stenosis, moderate stenosis, and severe stenosis in CVI ≤ 65 .16 group and CVI > 65.16% group were statistically significant (P < 0.001).ConclusionCVI may be a useful indicator for early diagnosis and monitoring of choroidal vascular changes in ICA stenosis.

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“…ICA stenosis can cause changes in ocular hemodynamics [21]. The choroid blood flow is the most abundant part of the blood flow in the eye.…”

Section: Discussionmentioning

confidence: 99%

Choroidal vascular changes in internal carotid artery stenosis: a retrospective cohort study in Chinese population

Lang

Wang

et al. 2019

BMC Ophthalmol

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“…The use of interventions for carotid artery occlusive diseases may improve choroidal blood flow in patients with OIS [30–33]. This improvement in carotid artery blood flow using an intervention may not completely reverse the OIS, but it may prevent further visual loss associated with OIS and improve vision in some patients without neovascular glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis

et al. 2019

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PurposeTo evaluated the changes in choroidal vasculature in patients with ocular ischemic syndrome (OIS) and in the ipsilateral eyes of patients with symptomatic carotid artery stenosis (CAS)MethodA total of 50 patients (15 patients with OIS, 10 patients with symptomatic CAS, 25 patients of age-and sex-matched control group) were included, and the medical records were retrospectively reviewed. The mean subfoveal choroidal thickness (SFCT) of each eye was measured, and binary images of the choroid were evaluated to compare the mean choroidal area and the luminal area.ResultsThe mean SFCT was 170.5±75.3 μm in the eyes with OIS, 154.8±62.9 μm in the ipsilateral eyes with symptomatic CAS, and 277.5±73.2 μm in the right eyes of the control group patients (P<0.001). The mean choroidal area was 494,478.6±181,846.2 μm2 in the eyes with OIS, 453,750.0±196,725.8 μm2 in the ipsilateral eyes with symptomatic CAS, and 720,520±281,319.5 μm2 in the control group eyes (P = 0.036). The mean luminal area was 333,185.7±112,665.9 μm2 in the eyes with OIS, 313,983.3±132,032.1 μm2 in the ipsilateral eyes with symptomatic CAS, and 480,325.0±185,112.6 μm2 in the control group eyes (P = 0.046). The mean SFCT, mean choroidal area, and mean luminal area were significantly smaller in the eyes with OIS (P = 0.017, P = 0.005, and P = 0.004, respectively), and those with symptomatic CAS (P = 0.020, P = 0.016, and P = 0.021, respectively) than in the unaffected contralateral eyes. There were no significant differences between the eyes in the control group (P = 0.984, P = 284, and P = 0.413, respectively).ConclusionThe mean SFCT, mean choroidal area, and mean luminal area were significantly thinner in the eyes with OIS and the ipsilateral eyes with symptomatic CAS, compared with the control group eyes. The eyes with OIS and those with symptomatic CAS had significantly thinner SFCT, and smaller choroidal area and luminal area than the unaffected contralateral eyes. Choroid may reflect the vascular status of the carotid artery, indicated by choroidal thinning and decreasing choroidal area, especially luminal area.

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“…In patients with ocular ischemic syndrome due to ipsilateral carotid artery stenosis, color Doppler ultrasound of the ophthalmic artery was performed before and after surgical treatment. Multiple studies found an improvement in ocular blood flow postoperatively and found that endarterectomy was effective in improving or preventing the progression of ocular ischemia caused by CAS [141,142].…”

Section: Changes In Ophthalmic Artery Blood Flow Velocity Associated With Casmentioning

confidence: 99%

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

et al. 2021

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Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.

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Changes in Ocular Hemodynamics after Carotid Artery Angioplasty and Stenting (CAAS) in Patients with Different Severity of Ocular Ischemic Syndrome

Abstract: CAAS can greatly improve ocular blood in OIS patients with and without iris neovascularization. However, CAAS improved BCVA only in patients without iris neovascularization.

Cited by 17 publications

References 19 publications

Choroidal vascular changes in internal carotid artery stenosis: a retrospective cohort study in Chinese population

Choroidal vascular changes in internal carotid artery stenosis: a retrospective cohort study in Chinese population

Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

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