Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.
Department of Ophthalmology, Tan Tock Seng Hospital, National Health Group Eye Institute, Singapore.
Invest Ophthalmol Vis Sci. 2023 Dec 1;64(15):42. doi: 10.1167/iovs.64.15.42.
The impact of carotid endarterectomy (CEA) on choriocapillaris (CC) perfusion was investigated using swept-source optical coherence tomography angiography (SS-OCTA) imaging before and after surgery in patients with clinically significant carotid artery stenosis (CAS).
In this prospective observational study, patients with clinically significant CAS undergoing unilateral CEA had SS-OCTA imaging performed in both eyes before and within 1 week after surgery. The percent CC flow deficits (CC FD%) and CC thickness were assessed using previously validated algorithms. Multivariable regression analysis was conducted to evaluate the impact of variables on the change in CC measurements.
A total of 112 eyes from 56 patients with an average age of 72.6 ± 6.9 years were enrolled. At baseline, significantly higher CC FD% and thinner CC thickness were observed on the surgical side (eyes ipsilateral to the side of CEA) versus the nonsurgical side (eyes contralateral to the side of CEA) (P = 0.001 and P = 0.03, respectively). Following CEA, a significant reduction in CC FD% and a significant increase in CC thickness were detected on the surgical as compared with the nonsurgical side (P = 0.008 and P = 0.01, respectively). Smoking status positively affected CC FD% change (coefficient of variation [CV] = 0.84, P = 0.01) on the surgical side and negatively affected CC thickness change on both the surgical side (CV = -0.382, P = 0.009) and the nonsurgical side (CV = -0.321, P = 0.04). The degree of stenosis demonstrated a positive influence on CC FD% change (CV = 0.040, P = 0.02) on the surgical side.
Unilateral CEA on the side of clinically significant CAS increases carotid blood flow, which further results in improved CC perfusion.
使用扫频源光学相干断层血管造影（SS-OCTA）成像，在接受有临床意义的颈动脉狭窄（CAS）单侧颈动脉内膜切除术（CEA）的患者术前和术后，研究 CEA 对脉络膜毛细血管（CC）灌注的影响。
在这项前瞻性观察研究中，对有临床意义的 CAS 接受单侧 CEA 的患者，在术前和术后 1 周内对双眼进行 SS-OCTA 成像。使用先前验证的算法评估 CC 血流缺损百分比（CC FD%）和 CC 厚度。进行多变量回归分析，以评估变量对 CC 测量值变化的影响。
共纳入 56 例患者的 112 只眼，平均年龄为 72.6±6.9 岁。在基线时，与非手术侧（CEA 侧对侧）相比，手术侧（CEA 侧）的 CC FD%显著更高，CC 厚度更薄（P=0.001 和 P=0.03）。与非手术侧相比，CEA 后手术侧的 CC FD%显著降低，CC 厚度显著增加（P=0.008 和 P=0.01）。吸烟状态对手术侧的 CC FD%变化有积极影响（变异系数[CV]为 0.84，P=0.01），对手术侧和非手术侧的 CC 厚度变化有负面影响（CV 分别为-0.382，P=0.009 和-0.321，P=0.04）。狭窄程度对手术侧的 CC FD%变化有积极影响（CV 为 0.040，P=0.02）。
有临床意义的 CAS 侧的单侧 CEA 增加了颈动脉血流量，进而导致 CC 灌注改善。
