Key result
In patients with significant carotid artery stenosis, hypertension significantly reduced macular vessel density (Beta -1.46), while statin use and carotid surgery substantially improved ocular microcirculation.
Why the study?
Retinal microvasculature provides a unique opportunity to evaluate cerebral small vessel disease in vivo, prompting this study to analyze the effect of systemic risk factors on retinal blood flow using optical coherence tomography angiography in patients with significant carotid artery stenosis.
Do systemic risk factors and carotid endarterectomy affect retinal blood flow in patients with significant carotid artery stenosis?
Cohort (n=56)
No
Do systemic risk factors and carotid endarterectomy affect retinal blood flow in patients with significant carotid artery stenosis?
Mean Difference: -1.46 (95% CI -2.23–-0.68)
p-value: p=<0.001
Systemic factors like hypertension and eGFR, as well as statin use and carotid endarterectomy, significantly impact retinal microcirculation in patients with severe carotid stenosis.
Should not yet change carotid stenosis management; hypothesis-generating for retinal imaging as a microcirculation biomarker.
Carotid artery stenosis (CAS) is among the leading causes of mortality and permanent disabilities in the Western world. CAS is a consequence of systemic atherosclerotic disease affecting the majority of the aging population. Optical coherence tomography angiography (OCTA) is a novel imaging technique for visualizing retinal blood flow. It is a noninvasive, fast method for qualitative and quantitative assessment of the microcirculation. Cerebral and retinal circulation share similar anatomy, physiology, and embryology; thus, retinal microvasculature provides a unique opportunity to study the pathogenesis of cerebral small vessel disease in vivo. In this study, we aimed to analyze the effect of systemic risk factors on retinal blood flow in the eyes of patients with significant carotid artery stenosis using OCT angiography. A total of 112 eyes of 56 patients with significant carotid stenosis were included in the study. We found that several systemic factors, such as decreased estimated glomerular filtration rate (eGFR), hypertension, and carotid occlusion have a significant negative effect on retinal blood flow, while statin use and carotid surgery substantially improve ocular microcirculation. Neither diabetes, clopidogrel or acetylsalicylic acid use, BMI, serum lipid level, nor thrombocyte count showed a significant effect on ocular blood flow. Our results demonstrate that a systematic connection does exist between certain systemic risk factors and retinal blood flow in this patient population. OCTA could help in the assessment of cerebral circulation of patients with CAS due to its ability to detect subtle changes in retinal microcirculation that is considered to represent changes in intracranial blood flow.
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István et al. (2021) conducted a cohort in Carotid artery stenosis (n=56). Systemic risk factors (e.g., hypertension) and carotid surgery vs. Absence of risk factors / baseline was evaluated on Macular vessel density (superficial capillary layer) (Beta -1.46, 95% CI -2.23 to -0.68, p=<0.001). In patients with significant carotid artery stenosis, hypertension significantly reduced macular vessel density (Beta -1.46), while statin use and carotid surgery substantially improved ocular microcirculation.
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