Retinal vessel dynamic functionality in the eyes of asymptomatic patients with significant internal carotid artery stenosis

Machalińska, Anna; Kawa, Miłosz; Babiak, Katarzyna; Sobuś, Anna; Grabowicz, Aleksandra; Lejkowska, Renata; Kazimierczak, Arkadiusz; Rynio, Paweł; Safranow, Krzysztof; Wilk, Grażyna; Gutowski, Piotr

doi:10.23736/s0392-9590.19.04112-9

Cited by 16 publications

(25 citation statements)

References 43 publications

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“…Therefore, retinal microvascular abnormalities are considered to reflect the degree of cerebral microvascular disease [7]. Several studies [8][9][10][11] have confirmed that ocular manifestations can reflect the changes of carotid vessels; however, the potential of previously employed examination methods is limited. For example, a risk of allergy to contrast media exists in retinal angiography [12].…”

Section: Introductionmentioning

confidence: 99%

“…For example, a risk of allergy to contrast media exists in retinal angiography [12]. Moreover, other methods, such as retinal thickness [11] and fundus photography [10], do not possess adequate accuracy for the observation of tiny blood vessels. Optical coherence tomography angiography (OCTA) is a new technology that provides high-resolution retinal vascular images suitable for direct observation of 5 μm capillaries.…”

Section: Introductionmentioning

confidence: 99%

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Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Zhu

Zhou

et al. 2021

Disease Markers

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Purpose. Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion. Methods. In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t -test was used to evaluate the preoperative and postoperative changes in OCTA variables. Results. The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161 ; SVC: 48.65 vs. 52.22, P = 0.0006 ; DVC: 49.65 vs. 57.50, P < 0.0001 ). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001 ; SVC, P = 0.0104 ; DVC, P = 0.0104 ). Moreover, the ocular perfusion was consistent with that established by CTP. Conclusion. OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Zhu

Zhou

et al. 2021

Disease Markers

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“…These post-surgical benefits to retinal structure and function benefits may not be accompanied by improvements in retinal neurovascular coupling. For example, the decreased flicker stimulation-evoked retinal venous dilation in CAS patients discussed earlier was not improved after carotid endarterectomy [136]. These results suggest that CAS-associated microvascular dysfunction may not be resolved by restoring the luminal diameter of the carotid artery.…”

Section: Effects Of Cas and Its Surgical Treatment (Carotid Endarterectomy) On The Retinamentioning

confidence: 76%

“…Support for this hypothesis comes from a recent DVA study evaluating CAS patients [136]. Flicker stimulation-evoked retinal venous dilation was decreased significantly in both eyes of CAS patients versus controls [136]. Combined these findings support a link between defects in retinal neuronal function, retinal vascular dysfunction, and CAS.…”

Section: Effect Of Carotid Artery Disease On Retinal Function and Structuresmentioning

confidence: 90%

“…As in the brain, where defects in neurovascular coupling can lead to neuronal dysfunction and cognitive decline, defects in retinal function in CAS patients may be tied to impaired retinal neurovascular coupling. Support for this hypothesis comes from a recent DVA study evaluating CAS patients [136]. Flicker stimulation-evoked retinal venous dilation was decreased significantly in both eyes of CAS patients versus controls [136].…”

Section: Effect Of Carotid Artery Disease On Retinal Function and Structuresmentioning

confidence: 98%

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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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Quantitative assessment of retinochoroidal microvasculature in patients with carotid artery stenosis using OCT angiography

Li,

Zhao,

Jian

et al. 2024

Photodiagnosis and Photodynamic Therapy

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Retinal vessel dynamic functionality in the eyes of asymptomatic patients with significant internal carotid artery stenosis

Cited by 16 publications

References 43 publications

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by 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

Quantitative assessment of retinochoroidal microvasculature in patients with carotid artery stenosis using OCT angiography

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