Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion

Abstract

Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV) in patients of carotid stenosis (CS) with or without contralateral carotid occlusion (CO) early after carotid endarterectomy (CEA). Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD) and Color Doppler Imaging (CDI) were performed before and early after CEA. Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA) and middle cerebral artery (MCA) on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA) retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA) of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO. Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

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

“…Carotid endarterectomy is considered an effective method for reducing brain stroke risk in patients with severe ICAS [32,33]. Numerous studies have shown its beneficial effect on blood flow in the ophthalmic artery, central retinal artery, posterior ciliary arteries, and chorioretinal circulation using Doppler ultrasonography and laser speckle flowgraphy [21,22,26]. Our study revealed significant differences in subfoveal choroidal thickness and volume 3 months after carotid endarterectomy compared to baseline in the EIS group.…”

“…e medical review of choroidal thickness in ICAS without ischaemic ocular syndrome gives conflicting results. Wang et al, based on a group of 219 patients with unilateral severe ICAS, found that the mean SFCT of the carotid stenosis group was significantly lower compared to that of normal eyes, probably in the mechanism of insufficient blood perfusion of the posterior ciliary arteries and choriocapillaris [22]. Similarly, Sayin et al compared the eyes of severe ICAS patients with those of healthy volunteers and found a significantly thinner central choroid in the former group [29].…”

“…Additionally, the analysis of changes in CV after surgery showed a strong positive correlation between the EIE and ECE groups. e CEA improves contralateral cerebral and ocular perfusion through the circle of Willis and ophthalmic arteries in the so-called redistribution phenomenon [22,34]. Unilateral surgery for significant carotid artery stenosis may improve the ocular circulation on the opposite side.…”

“…Insufficient blood supply to the eye due to internal carotid artery stenosis (ICAS) may manifest as acute or chronic ischaemic symptoms [17][18][19][20]. Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving cerebral and ocular circulation [21][22][23]. Moreover, improvements in blood flow within the ophthalmic, central retinal, and posterior ciliary arteries as well as in the retinal and choroidal circulation have been documented [21,22,[24][25][26].…”

The Role of Neurosonology in the Diagnosis and Management of Patients with Carotid Artery Disease: A Review

“…TCD, complemented with a breath holding test, can be used to document the flow improvement in proximal intracranial arteries following carotid artery reperfusion. The examiner verifies the increase of MFV in the ispilateral MCA and ACA and the restoration of flow reversal in the OA . In cases with contralateral occlusions, MFV increase bilaterally, BHI improves ispilateral to the occlusion, and cross‐flow toward the occlusion via the AComA is reinforced …”