Changes of retinal structure and function in patients with internal carotid artery stenosis

Wu, Dong-Hui; Wu, Lan-Ting; Wang, Yanling; Wang, Jialin

doi:10.1186/s12886-022-02345-7

Cited by 9 publications

(5 citation statements)

References 30 publications

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“… 26 – 30 Shakur et al 13 used magnetic resonance angiography (MRA) and DSA to show that increasing degree of stenosis resulted in significantly decreased antegrade ICA blood flow in patients with CAS. A previous study 31 using the retinal camera in patients with CAS demonstrated that as the degree of carotid artery stenosis increased, the diameter of the retinal vessels around the optic nerve head decreased significantly. However, we showed that an increased degree of stenosis plaque only correlated with decreased retinal microvascular densities in our patients with severe CAS.…”

Section: Discussionmentioning

confidence: 96%

Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients

Cao,

Wang,

Kwapong

et al. 2023

Trans. Vis. Sci. Tech.

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Purpose We explored the retinal microvascular changes in carotid artery stenosis (CAS) and their relationship with carotid plaque morphology. Methods All participants were diagnosed with carotid artery stenosis by a neurologist. Participants underwent digital subtraction angiography (DSA) and optical coherence tomography angiography (OCTA) imaging. The degree and length of carotid plaque were obtained from the DSA tool. OCTA tool measured the densities in the superficial vascular complex (SVC) and deep vascular complex (DVC). Results One hundred seventeen patients with CAS patients were included in our data analysis. Eyes with ipsilateral stenosis had reduced retinal microvascular densities when compared to contralateral eyes in patients with CAS ( P = 0.016 for SVC, and P = 0.004 for DVC). Microvascular densities correlated with the length of carotid plaque ( P = 0.015 for SVC, and P = 0.022 for DVC) in our CAS cohort, although they did not correlate with the degree of carotid plaque ( P = 0.264 for SVC, and P = 0.298 for DVC). However, when stratified into moderate and severe subgroups, the degree of carotid plaque correlated with microvascular densities in patients with severe stenosis ( P = 0.045 for SVC, and P = 0.038 for DVC). Conclusions Our study suggests that OCTA can noninvasively detect retinal microvascular changes in patients with CAS and that these changes correlated with the length of the stenosis, but future studies are required to confirm these findings. Translational Relevance Noninvasive and rapid acquisition of the OCTA image might have the potential to be used as a screening tool to detect microvascular changes in carotid artery stenosis.

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Section: Discussionmentioning

confidence: 96%

Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients

Cao,

Wang,

Kwapong

et al. 2023

Trans. Vis. Sci. Tech.

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“… 42 Because MMD is relevant to ICA occlusion and ICA stenosis is relevant to the retinal vein, it is important for models to highlight the main vasculature region of the images. 43 The GradCAM showed that the retinal images of the patient with MMD focused on the main vasculature, unlike the heatmap of a healthy patient, which highlighted nonvasculature areas. The deep learning method was effective in providing evidence for the presence of retinal vasculature occlusion in patients with MMD.…”

Section: Discussionmentioning

confidence: 99%

Screening of Moyamoya Disease From Retinal Photographs: Development and Validation of Deep Learning Algorithms

Hong,

Yoon,

Shim

et al. 2024

Stroke

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BACKGROUND: Moyamoya disease (MMD) is a rare and complex pathological condition characterized by an abnormal collateral circulation network in the basal brain. The diagnosis of MMD and its progression is unpredictable and influenced by many factors. MMD can affect the blood vessels supplying the eyes, resulting in a range of ocular symptoms. In this study, we developed a deep learning model using real-world data to assist a diagnosis and determine the stage of the disease using retinal photographs. METHODS: This retrospective observational study conducted from August 2006 to March 2022 included 498 retinal photographs from 78 patients with MMD and 3835 photographs from 1649 healthy participants. Photographs were preprocessed, and an ResNeXt50 model was developed. Model performance was measured using receiver operating curves and their area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score. Heatmaps and progressive erasing plus progressive restoration were performed to validate the faithfulness. RESULTS: Overall, 322 retinal photographs from 67 patients with MMD and 3752 retinal photographs from 1616 healthy participants were used to develop a screening and stage prediction model for MMD. The average age of the patients with MMD was 44.1 years, and the average follow-up time was 115 months. Stage 3 photographs were the most prevalent, followed by stages 4, 5, 2, 1, and 6 and healthy. The MMD screening model had an average area under the receiver operating characteristic curve of 94.6%, with 89.8% sensitivity and 90.4% specificity at the best cutoff point. MMD stage prediction models had an area under the receiver operating characteristic curve of 78% or higher, with stage 3 performing the best at 93.6%. Heatmap identified the vascular region of the fundus as important for prediction, and progressive erasing plus progressive restoration result shows an area under the receiver operating characteristic curve of 70% only with 50% of the important regions. CONCLUSIONS: This study demonstrated that retinal photographs could be used as potential biomarkers for screening and staging of MMD and the disease stage could be classified by a deep learning algorithm.

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“…A possible autoregulation of foveal microvasculature as a physiologic protective mechanism remains to be highlighted. A previous study showed mean retinal sensitivity was lower in patients with moderate CAS compared to healthy controls, but retinal sensitivity in the foveal region did not differ between groups, and the authors concluded that the reason was possibly related to a larger number of cones in the foveal area [ 19 ]. Another study found that CAS mainly affects the rod-mediated response [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Retinal Microvascular Changes in Internal Carotid Artery Stenosis

Batu Oto,

Kılıçarslan,

Kayadibi

et al. 2023

JCM

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Purpose: We aimed to analyze retinal microvascular parameters, measured by optical coherence tomography angiography in patients with internal carotid artery stenosis compared to healthy individuals. Materials and Methods: A total of 41 eyes from 30 patients who had varying degrees of carotid stenosis, and 42 eyes from 42 healthy controls, were enrolled in this study. Depending on the degree of stenosis evaluated by Doppler ultrasonographic imaging, the patient group was further subclassified into mild, moderate, and severe carotid artery stenosis. Superficial and deep capillary plexus vessel densities, radial peripapillary capillary vessel density, foveal avascular zone, and flow densities in the choriocapillaris and outer retina were evaluated by optical coherence tomography angiography. Results: The superficial and deep capillary plexus vessel densities were significantly reduced among the groups, only sparing the foveal region. The mean superficial plexus vessel density was 45.67 ± 4.65 and 50.09 ± 4.05 for the patient and control group, respectively (p = 0.000). The mean deep capillary plexus density was 46.33% ± 7.31% and 53.27% ± 6.31% for the patient and control group, respectively (p = 0.000). The mean superficial and deep capillary vessel densities in the foveal region did not show any statistical difference between the patient and control groups (p = 0.333 for the superficial and p = 0.195 for the deep plexus vessel density). Radial peripapillary capillary vessel density was decreased in the patient group (p = 0.004). The foveal avascular zone area was wider in the patient group but this difference did not show a significant difference (p = 0.385). Conclusions: Retinal microvascular changes are a prominent outcome of internal carotid disease, and even mild stenosis can lead to alterations in the retinal microvascular bed which could be detected by OCTA. By early detection of microvascular changes in the retina in this patient group, we might speculate the overall vascular condition.

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Changes of retinal structure and function in patients with internal carotid artery stenosis

Cited by 9 publications

References 30 publications

Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients

Length of Carotid Plaque Impacts Retinal Microvascular Densities of Carotid Artery Stenosis Patients

Screening of Moyamoya Disease From Retinal Photographs: Development and Validation of Deep Learning Algorithms

Retinal Microvascular Changes in Internal Carotid Artery Stenosis

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