Study on the Correlation between Internal Carotid Artery Stenosis and Microvascular Characteristics in Macular Lutea by Optical Coherence Tomography Angiography
Objective To explore the microvascular characteristics of the macular lutea in patients with internal carotid artery stenosis (ICAS) and their correlation with vascular stenosis using optical coherence tomography angiography (OCTA).Methods Patients diagnosed with ICAS through vascular assessment,who were admitted to the Department of Neurology and Neuro-Ophthalmology at The First Hospital of Xi'an (The First Affiliated Hospital of Northwest University) from January 2023 to September 2024,were consecutively included.Patients were grouped according to the lesion side and stenosis degree.Age,gender,and medical history-matched participants were included as a healthy control group.OCTA examinations were conducted in the macular lutea for the enrolled subjects,and the data of small vessel density,vessel density,perfusion area,volume of medium to large choroidal vessels,and vascular index were all collected for inter-group comparison.Results A total of 66 subjects were included in this study,including 20 cases in the unilateral ICAS group,26 cases in the bilateral ICAS group,and 20 cases in the healthy control group.Among them,54 (81.8％) were male,with an average age of (67.5±8.7) years.There were no statistically significant differences in clinical characteristics among the three groups,except for the history of previous stroke or TIA.Compared with the healthy control group,the perfusion area of the choroidal capillary layer in both eyes of the unilateral ICAS group was lower than that of the healthy control group.However,there were no statistically significant differences in these indicators between both eyes of the unilateral ICAS patients.Compared with the healthy control group,there were statistically significant differences in the small vessel density of the superficial vascular complex,the perfusion area of the inner retinal layer,the perfusion area of the choroidal capillary layer,the vessel density of the inner retinal layer,and the vessel density of the superficial vascular complex in the bilateral ICAS group (P＜0.05).Pairwise comparisons showed that the above indicators in the severe stenosis side were all lower than those in the healthy control group (P＜0.05).However,in the mild stenosis side,only the perfusion area of the choroidal capillary layer and vessel density of the inner retinal layer were lower than those in the healthy control group (P＜0.05).Although the indicators in the severe stenosis side tended to be lower than those in the mild stenosis side,the differences were not statistically significant (P＞0.05).All eyes with ICAS were divided into moderate and below (31 cases) and severe and above (41 cases) stenosis groups.When comparing these two groups with the healthy control group,it was found that the differences in small vessel density of the superficial vascular complex,the perfusion area of the choroidal capillary layer,the vessel density of the inner retinal layer,and the vessel density of the superficial vascular complex were statistically significant (P＜0.05).Although the indicators between the stenosis groups showed a further decreasing trend with the degree of stenosis,the differences were not statistically significant (P＞0.05).Conclusions In ICAS patients,microvascular indicators in the macular lutea were reduced compared to those in the healthy control group.Unilateral ICAS lesions can lead to impaired macular microcirculation in both eyes,with the degree of impairment influenced by the severity of stenosis.
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