Objective To investigate the clinical characteristics and mechanisms of ocular manifestations related to carotid artery stenosis. Methods The general clinic data and related ocular manifestations in 124 patients with carotid artery stenosis were retrospectively. Results In the 124 patients, 36 (29%) had ocular manifestations, and 28 (22. 6 %) complained the ocular discomfort as the first symptom. Among the 36 patients, 31 patients (86.1%) had been disclosed unilateral or double stenosis of internal carotid artery by carotid Doppler ultrasound examination, and the result of digital subtract angiography revealed middle and severe degree of internal carotid artery stenosis in 8 and 23 patients respectively. There was no statistic difference of incidence of ocular manifestations between 67 patients of severe internal carotid artery stenosis and 34 patients with middle one（chi;２test,P =0.266 2，P＞0.05). The ocular manifestations included amaurosis fugax (52.8%),acute decline or loss of the visual ability and defect of visual fields (36.1%), binocular diplopia (13.9%), ptosis (13.9%), and persistent high intraocular pressure(2.8%) one patient might had several ocular manifestations simultaneously. In 36 patients, central retinal artery occlusion had been diagnosed in 4, venous stasis retinopathy in 1,central or branch retinal vein occlusion in 6, neovascular glaucoma in 1, and anterior ischemic opticneuropathy in 2. One patient with double occlusion of internal carotid artery didnrsquo;t have any ocular manifestation. Conclusion Carotid artery stenosis, especially internal carotid artery may lead to acute or chronic ocular ischemic lesions, and the occurrence of ocular manifestations in chronic ocular ischemic lesions relates to compensa tion of collateral circulation；patients with ocular ischemic lesions are recomm end to undergo a routine carotid artery examination. (Chin J Ocul Fundus Dis, 2006,22:376-378)
ObjectiveTo observe the effects of carotid artery stenting (CAS) on ophthalmic artery blood flow in patients with ischemic ophthalmopathy (IOP).MethodsA prospective case-control study. Sixty IOP patients (60 eyes) who met inclusive criteria for CAS were enrolled in this study. There was 50% stenosis of internal carotid artery on one side at least confirmed by color doppler flow imaging (CDFI). Among 60 eyes, there were 3 eyes with central retinal artery occlusion, 15 eyes with retinal vein occlusion, 37 eyes with ischemic optic neuropathy, 5 eyes with ocular ischemia syndrome. The patients were randomly divided into CAS group (32 eyes of 32 patients) and medicine therapy group (28 eyes of 28 patients). The difference of age (t=1.804) and sex (χ2=1.975) between two groups was not significant (P＞0.05). The examinations of fundus fluorescein angiography (FFA), CDFI and digital substraction angiography (DSA) were performed before, 1 week and 6 months after treatment. The following parameters were recorded: arm-retinal circulation time (A-Rct), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the ophthalmic artery (OA) and central retinal artery (CRA), and the best corrected visual acuity (BCVA).ResultsThere was no significant differences in A-Rct (t=1.354) and BCVA (t=0.376) between the two groups before treatment (P＞0.05). Also, there was no significant differences in PSV (t=−0.294, −2.446), EDV (t=0.141, −0.305), and RI (t=−0.222, −0.694) of OA and CRA between the two groups before treatment before treatment (P＞0.05). Compared with the medicine therapy group, the lower A-Rct was found in the CAS group at different time points after the treatment. The difference was significant on 1 week after treatment (t=−3.205, P＜0.05), but not on 6 months after treatment (t=1.345, P＞0.05). The BCVA of eyes in the two groups were increasing with the extending of time of therapy. Compared with the medicine therapy group, the better BCVA was found in the CAS group at different time points after the treatment (t=0.800, 1.527; P＜0.05). Compared with the medicine therapy group, the higher PSV, EDV and lower RI of OA and CRA were found in the CAS group at different time points after the treatment. (P＜0.05).ConclusionCompared with conventional medicine therapy, CAS shows earlier effects in improving ocular hemodynamics for IOP patients with carotid artery stenosis, which benefits visual function improvement of the patients.
ObjectiveTo analysis the risk factors for carotid stenosis in patients with ischemic cerebrovascular disease based on digital subtraction angiography. MethodsA total of 312 patients diagnosed with ischemic cerebrovascular disease who underwent digital subtraction angiography from June 2011 to September 2013 were selected.The risk factors of carotid stenosis were analysised by multivariate logistic regression analysis. ResultsIn 312 patients,271 were with cerebral infarction and 41 were transient ischemic attack patients.There were 149 patients in carotid stenosis group (stenosis degree ≥50%) and 163 patients in control group (stenosis degree<50%).The age (OR=1.037,P=0.000) and coronary heart disease (OR=4.121,P=0.001) were independent risk factors of carotid stenosis with ischemic cerebrovascular disease. ConclusionCarotid stenosis is common in ischemic cerebrovascular disease.Age and coronary heart disease were the independent risk factors.The recognition and control of these risk factors are in favor of secondary prevention of ischemic cerebrovascular disease.
ObjectiveTo summarize our experience in treating highrisk carotid stenosis. MethodsWe retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with highrisk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. ResultsAll patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. ConclusionSelective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with highrisk carotid stenosis.
ObjectiveTo explore the utility of machine learning-based radiomics models for risk stratification of severe asymptomatic carotid stenosis (ACS). MethodsThe clinical data and head and neck CT angiography images of 188 patients with severe carotid artery stenosis at the Department of Cardiovascular Surgery, China-Japan Friendship Hospital from 2017 to 2021 were retrospectively collected. The patients were randomly divided into a training set (n=131, including 107 males and 24 females aged 68±8 years), and a validation set (n=57, including 50 males and 7 females aged 67±8 years). The volume of interest was manually outlined layer by layer along the edge of the carotid plaque on cross-section. Radiomics features were extracted using the Pyradiomics package of Python software. Intraclass and interclass correlation coefficient analysis, redundancy analysis, and least absolute shrinkage and selection operator regression analysis were used for feature selection. The selected radiomics features were constructed into a predictive model using 6 different supervised machine learning algorithms: logistic regression, decision tree, random forest, support vector machine, naive Bayes, and K nearest neighbor. The diagnostic efficacy of each prediction model was compared using the receiver operating characteristic (ROC) curve and the area under the curve (AUC), which were validated in the validation set. Calibration and clinical usefulness of the prediction model were evaluated using calibration curve and decision curve analysis (DCA). ResultsFour radiomics features were finally selected based on the training set for the construction of a predictive model. Among the 6 machine learning models, the logistic regression model exhibited higher and more stable diagnostic efficacy, with an AUC of 0.872, a sensitivity of 100.0%, and a specificity of 66.2% in the training set; the AUC, sensitivity and specificity in the validation set were 0.867, 83.3% and 78.8%, respectively. The calibration curve and DCA showed that the logistic regression model had good calibration and clinical usefulness. ConclusionThe machine learning-based radiomics model shows application value in the risk stratification of patients with severe ACS.
Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
Objective To observe the choroidal blood flow and morphological changes in patients with severe stenosis of internal carotid artery stenosis (ICAS). Methods A retrospective case-control study. Forty-six patients (46 eyes) with ICAS were enrolled in this study. There was severe stenosis in one side (the eyes in this side were set as case group) and mild or no stenosis in other side (the eyes in this side were set as control group). Color doppler ultrasound (CDI) was used to observe the changes of hemodynamic parameters of the ophthalmic artery (OA) and posterior ciliary artery (PCA), the main parameters of ultrasound Doppler imaging are peak systolic velocity (PSV), end diastolic velocity (EDV), resistance indices (RI) and the calculation of the pulsation indices (PI) through the use of a formula. Enhanced binarization of deep imaging coherence tomography (EDI-OCT) was used to measure the subfoveal choroidal thickness (SFCT). The total subfoveal choroidal area (TCA), luminal (LA), stromal (SA) and choroidal vascularity index (CVI) were obtained by modified image binarization technique. Results In the case group, the PSV in the OA and PCA was significantly lower than that of the control group (t=−2.200, −2.612; P=0.030, 0.011). There were no significant differences in EDV, RI, PI of OA (t=0.337, −1.810, −1.848; P=0.737, 0.074, 0.068) and PCA (t=−1.160, 1.400, 0.815; P=0.249, 0.165, 0.417). The SFCT (t=−3.711, P＜0.001), TCA (t=−2.736, P=0.007), LA (t=−3.188, P=0.002) and CVI (t=−2.096, P=0.039) of the case group was significantly lower than that of the control group. There were no significant differences in SA (t=−1.262, P=0.210) and LA/SA (t=−1.696, P=0.093). Conclusion In severe stenosis ICAS eyes, the PSV in the PCA and SFCT, TCA, LA, CVI are decreased.
More and more people suffered from the car otid artery obstruction. It is reported that it's around 69% of these patients the first clinical manifes tation of carotid occlusive disease is the ocular ischemic syndrome. Owing to th e most symptoms of the ocular ischemic syndrome are very obscure, so there are a lways overlook or made a misdiagnosis of this entity in clinical. Fundus fluores cein angiography (FFA) is the best procedure to find this entity. We should pay close attention to notice the early phase of FFA. It is the most specific FFA si gn in ocular ischemic syndrome, and it is a distinctly unusual finding to find t he ocular ischemic syndrome. (Chin J Ocul Fundus Dis, 2008, 24: 79-81)