Effect of carotid endarterectomy on retinal function in 'asymptomatic' patients with hemodynamically significant carotid artery stenosis

Machalińska, Anna; Kowalska-Budek, Aleksandra; Kawa, Miłosz; Kazimierczak, Arkadiusz; Safranow, Krzysztof; Kirkiewicz, Marta; Rynio, Paweł; Wilk, Grażyna; Lubiński, Wojciech; Gutowski, Piotr

doi:10.20452/pamw.4064

Cited by 8 publications

(17 citation statements)

References 28 publications

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“…Unilateral surgery for significant carotid artery stenosis may improve the ocular circulation on the opposite side. is is consistent with our previous observations documenting a significant improvement in retinal bioelectrical function in the eyes ipsilateral and contralateral to CEA [31].…”

Section: Discussionsupporting

confidence: 94%

“…ese data are in concordance with our previous investigation documenting that CEA for asymptomatic carotid artery stenosis is reproducibly associated with improvement of retinal function [23,31]. 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.…”

Section: Discussionsupporting

confidence: 92%

“…Initially, the ischaemic changes may be subtle and clinically inaccessible. Accordingly, we recently demonstrated that the retinal bioelectrical function is negatively affected by haemodynamically significant ICAS despite the absence of objective clinical signs and symptoms of ocular ischaemia [31]. e medical review of choroidal thickness in ICAS without ischaemic ocular syndrome gives conflicting results.…”

Section: Discussionmentioning

confidence: 99%

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

Krytkowska

Masiuk

Kawa

et al. 2020

Journal of Ophthalmology

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Purpose. Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving ocular circulation. The choroid is a predominantly vascular tissue; thus, systemic and local vascular alterations may influence its morphology and function. The aim of the current study was to analyse changes in choroidal thickness and volume in patients with significant internal carotid artery stenosis (ICAS) before and after unilateral CEA. Methods. The 42 eyes of the 21 asymptomatic patients included in the study were divided into two groups: those ipsilateral (EIE) and those contralateral (ECE) to CEA. All participants underwent a complete ophthalmologic examination, including enhanced depth imaging-optical coherence tomography (EDI-OCT). A comparative analysis of subfoveal thickness (CT) and choroidal volume (CV) measured in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields at baseline, on the 2nd day after CEA, and in the 3rd month after CEA was performed. Results. In the EIE and ECE groups, no significant differences in either CT or CV values before and on the 2nd day after the CEA were observed. In the EIE group, a significant increase in CT and CV in the 3rd month after CEA compared to baseline was noted in the specific ETDRS region. Changes in CT and CV after surgery were positively correlated with the participants’ physical activity status and diastolic blood pressure and negatively correlated with the participants’ age and smoking status. Additionally, the analysis of changes in CV after CEA showed a positive correlation between the EIE and ECE groups. Conclusions. CT and CV fluctuations in the central and perifoveal areas visualized with EDI-OCT enabled the observation of the processes of tissue adaptation to variable blood flow conditions.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Krytkowska

Masiuk

Kawa

et al. 2020

Journal of Ophthalmology

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“…Previous studies demonstrated that unilateral carotid revascularization may improve cerebral blood flow and metabolism not only in the ipsilateral hemisphere but also in the contralateral hemisphere 17–19 . The improvements in bilateral retrobulbar ocular blood flow and electrophysiological responses of the retina were also identified 20,21 . Collateral blood flow supplying the hemodynamically compromised hemisphere came at the expense of reduced global cerebrovascular reserve.…”

Section: Discussionmentioning

confidence: 82%

Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting

Lee

Cheng

Chang

et al. 2019

Sci Rep

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The aim of the study was to evaluate the influence of carotid angioplasty and stenting (CAS) on retinal microvasculature using optical coherence tomography angiography (OCTA) in patients with severe carotid stenosis. 20 patients with severe carotid stenosis underwent comprehensive ophthalmic examinations and OCTA before and one month after CAS. Automated algorithms were used to quantify vessel density in the macular superficial vascular complex (SVC), deep vascular complex (DVC), and radial peripapillary capillary (RPC) around the optic disc. Eyes on the operated side constituted the ipsilateral eye group, and the other eye constituted the fellow eye group. In the ipsilateral eye group, the vessel density in the DVC increased significantly after stent implantation (P = 0.010), but the vessel density change in the SVC was not statistically different (P = 0.999). In the fellow eye group, the vessel density in the SVC (P = 0.028) and DVC (P = 0.034) were significantly increased after stent implantation. The vessel density in the RPC did not significantly change in the ipsilateral (P = 0.363) or fellow (P = 0.878) eye groups. This study shows that unilateral CAS for severe carotid stenosis increases macular vessel densities in both eyes.

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“…Recently, the amplitudes of the standard full-field electroretinogram in asymptomatic patients were revealed to significantly increase following carotid endarterectomy in the eyes both ipsilateral and contralateral to the surgery side [ 41 ]. It can be deduced from their results and ours that after CAS or carotid endarterectomy, the flow rates in the contralateral internal cerebral artery and collateral flow to the stented side decrease, those in both the ophthalmic arteries increase, and the flow rate in the contralateral middle cerebral artery remains the same.…”

Section: Discussionmentioning

confidence: 99%

Multiple blood flow measurements before and after carotid artery stenting via phase-contrast magnetic resonance imaging: An observational study

et al. 2018

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After carotid artery stenting, the procurement of information about blood flow redistribution among brain-feeding arteries and its time trend is essential to understanding a patient’s physiological background and to determine their care regimen. Cerebral blood flow has been measured twice following carotid artery stenting in few previous studies, with some discrepancies in the results. The purpose of this study was to measure cerebral blood flow at multiple time points after carotid artery stenting, and to elucidate the time trend of cerebral blood flow and redistribution among arteries. Blood flow rates in 11 subjects were measured preoperatively, at one day, one week, and about three months, respectively after carotid artery stenting by using phase-contrast magnetic resonance imaging. The target vessels were the bilateral internal carotid arteries, the basilar artery, and the bilateral middle cerebral arteries. Lumen was semi-automatically defined using an algorithm utilizing pulsatility. The results showed that blood flow rates in the stented internal carotid artery and the ipsilateral middle cerebral artery increased following carotid artery stenting. Blood flow rates in the contralateral internal carotid artery and the basilar artery gradually declined, and they were lower than the preoperative values at three months after stenting. The sum of blood flow rates of the bilateral internal carotid arteries and the basilar artery increased after carotid artery stenting, and then decreased over the next three months. There was no significant change in the blood flow rate in the contralateral middle cerebral artery. From these results, it was concluded that redistribution among the bilateral internal carotid arteries and the basilar artery occurs after carotid artery stenting, and that it takes months thereafter to reach another equilibrium.

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Effect of carotid endarterectomy on retinal function in 'asymptomatic' patients with hemodynamically significant carotid artery stenosis

Cited by 8 publications

References 28 publications

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

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

Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting

Multiple blood flow measurements before and after carotid artery stenting via phase-contrast magnetic resonance imaging: An observational study

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