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Evaluation of ocular blood flow in the assessment of symptomatic carotid stenosis

Matthew T Jones1, Sebastian Sanchez1, Rishi R Patel1

  • 1Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|April 18, 2023
PubMed

Insights

Laser speckle flowgraphy (LSFG) non-invasively measures ocular blood flow, offering a new way to assess internal carotid artery (ICA) stenosis severity and its impact on end-organ perfusion.

Area of Science:

  • Ophthalmology
  • Neurology
  • Vascular Surgery

Background:

  • North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria for internal carotid artery (ICA) stenosis may not fully reflect distal flow compromise.
  • Tandem carotid stenosis and collateral circulation significantly influence distal ICA perfusion.
  • Non-invasive quantification of end-organ ocular perfusion using laser speckle flowgraphy (LSFG) could offer insights into distal ICA flow.

Purpose of the Study:

  • To prospectively assess the degree of internal carotid artery (ICA) flow using laser speckle flowgraphy (LSFG).
  • To evaluate the correlation between LSFG-derived ocular blood flow metrics and the severity of ICA stenosis.
  • To determine the potential of LSFG in quantifying end-organ perfusion related to carotid stenosis.

Main Methods:

  • Eighteen patients with symptomatic carotid stenosis underwent LSFG evaluation, measuring ocular blood flow metrics (mean blur rate, flow acceleration index, rising rate) in the retina, choroid, and optic nerve head.
  • Digital subtraction angiography with Syngo iFlow was used to quantify contrast flow in the ICA and brain parenchyma, extracting time to peak and contrast delay from seven regions of interest.
  • Correlation analysis was performed between LSFG metrics and digital subtraction angiography findings.

Main Results:

  • Mean blur rate, flow acceleration index, and rising rate correlated with the degree of North American Symptomatic Carotid Endarterectomy Trial (NASCET) stenosis.
  • Flow acceleration index and rising rate showed improvement after stenting.
  • Time to peak improved in three regions of interest post-stenting, with a moderate negative correlation between flow acceleration index and contrast delay.

Conclusions:

  • Laser speckle flowgraphy (LSFG) provides a non-invasive method to quantify end-organ blood flow distal to the internal carotid artery (ICA) origin.
  • LSFG metrics demonstrate potential for quantifying end-organ perfusion.
  • LSFG may aid in determining if a proximal carotid stenosis is symptomatic.

Keywords:
Carotid stenosiscollateral circulationreperfusion

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