Choroidal Changes in Carotid Stenosis Patients After Stenting Detected by Swept-source Optical Coherence Tomography Angiography

Abstract

Background: Carotid artery stenosis (CAS) patients show reduced blood flow in the ophthalmic artery. This study aimed to assess the changes in the choriocapillaris and choroidal thickness in patients with unilateral carotid artery stenosis after carotid stenting using swept-source optical coherence tomography (SS-OCT)/swept-source optical coherence tomography angiography (SS-OCTA). Methods: Fifty-three mild to moderate CAS patients and 40 controls were enrolled in this study. All participants underwent digital subtraction angiography (DSA) and SS-OCT/SS-OCTAA imaging before and 4 days after carotid artery stenting. SS-OCTA was used to image and measure the perfusion of the choriocapillaris (mm2) while SS-OCT was used to image and measure the choroidal thickness (µm). The stenosed side was described as the ipsilateral eye while the other side was the contralateral eye. Results: Choroidal thickness was significantly thinner (P = 0.024) in CAS when compared with controls. Ipsilateral eyes of CAS patients showed significantly thinner (P = 0.008) choroidal thickness when compared with contralateral eyes. Ipsilateral eyes of CAS patients showed thicker (P = 0.027) choroidal thickness after carotid artery stenting while contralateral eyes showed thinner choroidal thickness (P = 0.039). Conclutions: Our report suggests that in vivo quantification of the choroid with the SS-OCT/SS-OCTA may allow monitoring of CAS and enable the assessment of purported treatments.

Retinal Thickness Correlates with Cerebral Hemodynamic Changes in Patients with Carotid Artery Stenosis

“…Sayin et al [ 21 ] showed significantly decreased choroidal thickness in CAS, while Rabina et al showed no significant difference in choroidal thickness of CAS patients compared to controls. In our study, we showed reduced CVV in ipsilateral eyes compared to contralateral eyes which is in line with our previous report [ 26 ]. Reduced choroidal vascular volume in the ipsilateral eyes may be linked with hypoperfusion due to irregularities in the choroidal blood flow; this may influence the functionality of the microvascular network which may induce a reduced blood flow pressure, ultimately resulting in the choroidal thinning [ 27 ].…”

“…To date, very little is known about the impact of carotid stenosis on choroidal circulation. Previous OCTA reports [ 16 , 26 ] did not find any significant difference in the choriocapillaris (the capillaries of the choroid) before and after stenting in CAS patients; the authors suggested changes seen in the choriocapillaris may be irrelevant in the choroid resulting in the insignificant differences. Similarly, our current report did not find a significant difference in the CVI of ipsilateral eyes compared to contralateral eyes.…”