Yusef Yu N, Semitko S P, Durzhinskaya M H, Kazaryan E E, Sargsyan A Z, Sandodze T S, Ioseliani D G, Budzinskaya M V
Research Institute of Eye Diseases, Moscow, Russia.
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Vestn Oftalmol. 2022;138(5. Vyp. 2):186-195. doi: 10.17116/oftalma2022138052186.
Carotid artery stenosis is the most common cause of ischemic stroke and transient ischemic attacks in the population of developed countries. Carotid endarterectomy (CEA) and carotid stenting (CAS) are effective treatments for carotid stenosis. In view of the need to improve the diagnosis of this condition and the anatomical relationship of the internal carotid arteries and vessels of the eye, studying retinal microvasculature has become an urgent problem. The theory suggesting that changes in ocular blood flow parameters may reflect disease status in patients with internal carotid artery (ICA) stenosis requires further investigation.
To study the impact of CEA and CAS interventions on ocular blood flow in patients with clinically significant ICA stenosis in the early postoperative period.
Thirty-two patients with hemodynamically significant stenosis (≥75%) of the left or right ICA were examined using optical coherence tomography angiography (OCT-A) and flowmetry before and after CEA or CAS in order to assess the changes in ocular blood flow parameters.
There were no significant differences in hemodynamic parameters in the eyes on the side of the stenotic and non-stenotic ICA before revascularization. In the early postoperative period (3-7 days) in the ipsilateral eyes, there was an increase in blood flow density and vascular density at the level of the superficial and deep plexuses in the macular area (≤0.05), as well as an increase in the ocular blood flow volume, the level of tolerated intraocular pressure (≤0.05) and a decrease in intraocular pressure (≤0.05) bilaterally. In the contralateral eyes, after ICA revascularization there was a partial improvement in microcirculation parameters according to OCT-A (≤0.05). Peripapillary blood flow density and peripapillary vessel density did not change significantly either on the ipsilateral or the contralateral side.
In patients with clinically significant ICA stenosis, ICA revascularization by stenting or endarterectomy contributed to an improvement in retinal microcirculation and retrobulbar blood flow in both eyes. OCT-A and flowmetry allow non-invasive assessment of retinal microvessels and retrobulbar blood flow, and the measurements provided by these methods can serve as valuable biomarkers for predicting and monitoring hemodynamic changes in patients who undergo CEA and CAS surgeries.
在发达国家人群中，颈动脉狭窄是缺血性卒中和短暂性脑缺血发作最常见的病因。颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）是治疗颈动脉狭窄的有效方法。鉴于改善这种疾病诊断以及颈内动脉与眼部血管解剖关系的需要，研究视网膜微血管系统已成为一个紧迫问题。认为眼血流参数变化可能反映颈内动脉（ICA）狭窄患者疾病状态的理论需要进一步研究。
研究CEA和CAS干预对具有临床意义的ICA狭窄患者术后早期眼血流的影响。
对32例左或右ICA血流动力学显著狭窄（≥75%）的患者在CEA或CAS术前及术后使用光学相干断层扫描血管造影（OCT - A）和血流测量法进行检查，以评估眼血流参数的变化。
血运重建前，狭窄侧和非狭窄侧ICA同侧眼的血流动力学参数无显著差异。术后早期（3 - 7天），同侧眼黄斑区浅、深丛水平的血流密度和血管密度增加（≤0.05），眼血流量增加，双侧耐受眼压水平增加（≤0.05），眼压降低（≤0.05）。对侧眼在ICA血运重建后，根据OCT - A显示微循环参数有部分改善（≤0.05）。视乳头周围血流密度和视乳头周围血管密度在同侧或对侧均无显著变化。
在具有临床意义的ICA狭窄患者中，通过支架置入术或内膜切除术进行ICA血运重建有助于改善双眼视网膜微循环和球后血流。OCT - A和血流测量法可对视网膜微血管和球后血流进行无创评估，这些方法提供的测量结果可作为预测和监测接受CEA和CAS手术患者血流动力学变化的有价值生物标志物。
