Changes in retinal flow density measured by optical coherence tomography angiography in patients with carotid artery stenosis after carotid endarterectomy

Larissa Lahme, Elena Marchiori, Giuseppe Panuccio, Pieter Nelis, Friederike Schubert, Natasa Mihailovic, Giovanni Torsello, Nicole Eter, Maged Alnawaiseh, Larissa Lahme, Elena Marchiori, Giuseppe Panuccio, Pieter Nelis, Friederike Schubert, Natasa Mihailovic, Giovanni Torsello, Nicole Eter, Maged Alnawaiseh

Abstract

The aim of the study presented here was to evaluate retinal and optic nerve head (ONH) perfusion in patients with severe asymptomatic carotid artery stenosis (CAS) compared with healthy controls and to analyze the impact of carotid endarterectomy using optical coherence tomography angiography (OCT-A). 25 eyes of 25 patients with CAS (study group) and 25 eyes of 25 healthy controls (control group) were prospectively included in this study. OCT-A was performed using RTVue XR Avanti (Optovue, Inc, Fremont, California, USA). The flow density data in the superficial and deep retinal OCT-angiogram of the macula and in the radial peripapillary capillary network (RPC) of the ONH were extracted and analyzed. The flow density in the superficial retinal OCT angiogram of the macula and in the ONH were significantly lower in the study group compared with the control group (macula: p = 0.003) (ONH: p = 0.013). The flow density in the ONH improved significantly after carotid endarterectomy (p = 0.004). A reduced flow density was observed in patients with CAS when compared with healthy controls. The flow density also improved after carotid endarterectomy. Quantitative changes in the microvascular density, as measured using OCT-A, could well be useful in the diagnosis of CAS and the evaluation of therapy success.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
OCT angiograms of a patient with CAS (Top row) and a healthy control (Bottom row).

References

    1. Fairhead JF, Rothwell PM. The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovasc Dis. 2005;19:355–358. doi: 10.1159/000085201.
    1. Warlow C, Farrell B, Fraser A, Sandercock P, Slattery J. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) The Lancet. 1998;351(9113):1379–1387. doi: 10.1016/S0140-6736(97)09292-1.
    1. Inzitari Domenico, Eliasziw Michael, Gates Peter, Sharpe Brenda L., Chan Richard K.T., Meldrum Heather E., Barnett Henry J.M. The Causes and Risk of Stroke in Patients with Asymptomatic Internal-Carotid-Artery Stenosis. New England Journal of Medicine. 2000;342(23):1693–1701. doi: 10.1056/NEJM200006083422302.
    1. Wang Dandan, Li Yang, Zhou Yong, Jin Cheng, Zhao Qi, Wang Anxin, Wu Shouling, Wei Wen Bin, Zhao Xingquan, Jonas Jost B. Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study. PLOS ONE. 2017;12(5):e0177277. doi: 10.1371/journal.pone.0177277.
    1. Montorsi P, Galli S, Ravagnani PM, Roffi M. Symptomatic Carotid Artery Disease: Revascularization. Prog Cardiovasc Dis. 2017;59(6):601–611. doi: 10.1016/j.pcad.2017.04.002.
    1. Brinjikji W, et al. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg. 2016;124(1):27–42. doi: 10.3171/2015.1.JNS142452.
    1. Heßler H, et al. No Evidence for Retinal Damage Evolving from Reduced Retinal Blood Flow in Carotid Artery Disease. Biomed Res Int. 2015;2015:604028. doi: 10.1155/2015/604028.
    1. Savastano Maria Cristina, Lumbroso Bruno, Rispoli Marco. IN VIVO CHARACTERIZATION OF RETINAL VASCULARIZATION MORPHOLOGY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2015;35(11):2196–2203. doi: 10.1097/IAE.0000000000000635.
    1. Kashani AH, et al. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res. 2017;2017(60):66–100. doi: 10.1016/j.preteyeres.2017.07.002.
    1. Alnawaiseh, M., Schubert, F., Heiduschka, P. & Eter, N. Optical coherence tomography angiography in patients with retinitis pigmentosa. Retina. 2017 Oct 24. [Epub ahead of print].
    1. Spaide RF, Fujimoto JG, Waheed NK. Image artifacts in optical coherence tomography angiography. Retina. 2015;35(11):2163–80. doi: 10.1097/IAE.0000000000000765.
    1. Meschia JF, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American. Stroke Association. Stroke. 2014;45:3754.
    1. Treder M, Lauermann JL, Alnawaiseh M, Heiduschka P, Eter N. Quantitative changes in flow density in patients with adult-onset foveomacular vitelliform dystrophy: an OCT angiography study. Graefes Arch Clin Exp Ophthalmol. 2018;256(1):23–28. doi: 10.1007/s00417-017-3815-6.
    1. Al-Sheikh M, Tepelus TC, Nazikyan T, Sadda SR. Repeatability of automated vessel density measurements using optical coherence tomography angiography. Br J Ophthalmol. 2017;101(4):449–452. doi: 10.1136/bjophthalmol-2016-308764.
    1. Alnawaiseh, M., Lahme, L., Müller, V., Rosentreter, A., Eter, N. Correlation of flow density, as measured using optical coherence tomography angiography, with structural and functional parameters in glaucoma patients. Graefes Arch Clin Exp Ophthalmol. 2018 Jan 13. [Epub ahead of print].
    1. Brand, C. et al. Aberrant ocular architecture and function in patients with Klinefelter syndrome. Sci Rep. Oct 13 7(1), 13130 (2017).
    1. Sayin N, Kara N, Uzun F, Akturk IF. A quantitative evaluation of the posterior segment of the eye using spectral-domain optical coherence tomography in carotid artery stenosis: a pilot study. Ophthalmic Surg Lasers Imaging Retina. 2015;46(2):180–5. doi: 10.3928/23258160-20150213-20.
    1. Kofoed PK, et al. Cone pathway function in relation to asymmetric carotid artery stenosis: correlation to blood pressure. Acta Ophthalmol. Dec. 2013;91(8):728–32. doi: 10.1111/j.1755-3768.2012.02438.x.
    1. Enaida H, et al. Changes in chorioretinal blood flow velocity and cerebral blood flow after carotid endarterectomy. Jpn J Ophthalmol. 2016;60(6):459–465. doi: 10.1007/s10384-016-0472-y.
    1. Costa VP, et al. Clinical findings and hemodynamic changes associated with severe occlusive carotid artery disease. Ophthalmology. 1997;104(12):1994–2002. doi: 10.1016/S0161-6420(97)30066-9.
    1. Cardia G, Porfido D, Guerriero S, Loizzi D, Giancipoli G. Retinal circulation after carotid artery revascularization. Angiology. 2011;62(5):372–375. doi: 10.1177/0003319710386472.
    1. Fujiwara Atsushi, Morizane Yuki, Hosokawa Mio, Kimura Shuhei, Shiode Yusuke, Hirano Masayuki, Doi Shinichiro, Toshima Shinji, Takahashi Kosuke, Hosogi Mika, Shiraga Fumio. Factors affecting foveal avascular zone in healthy eyes: An examination using swept-source optical coherence tomography angiography. PLOS ONE. 2017;12(11):e0188572. doi: 10.1371/journal.pone.0188572.
    1. Spaide RF, Curcio CA. Evaluation of Segmentation of the Superficial and Deep Vascular Layers of the Retina by Optical Coherence Tomography Angiography Instruments in Normal Eyes. JAMA Ophthalmol. 2017;135(3):259–262. doi: 10.1001/jamaophthalmol.2016.5327.
    1. Al-Sheikh M, GhasemiFalavarjani K, Akil H, Sadda SR. Impact of image quality on OCT angiography based quantitative measurements. Int J Retina Vitreous. 2017;15(3):13. doi: 10.1186/s40942-017-0068-9.
    1. Fenner, B. J. et al. Identification of imaging features that determine quality and repeatability of retinal capillary plexus density measurements in OCT angiography. Br. J Ophthalmol. 2017 Aug 16. [Epub ahead of print].
    1. Lareyre, F. et al. Changes in Ocular Subfoveal Choroidal Thickness After Carotid Endarterectomy Using Enhanced Depth Imaging Optical Coherence Tomography: A Pilot Study. Angiology. 3319717737223 (2017).
    1. Matsubara S, et al. Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting. Clinical article. J Neurosurg. 2009;111(1):28–36. doi: 10.3171/2008.09.17663.
    1. Yun TJ, et al. Effect of carotid artery stenting on cerebral blood flow: evaluation of hemodynamic changes using arterial spin labeling. Neuroradiology. 2013;55(3):271–281. doi: 10.1007/s00234-012-1104-y.

Source: PubMed

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