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A Murine Model of Ischemic Retinal Injury Induced by Transient Bilateral Common Carotid Artery Occlusion
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Retinal and Choroidal Vascular Alterations in Carotid Dissection Versus Atherosclerosis: Insights Into Divergent

Le Cao1, Hang Wang1, Wenzuo Shang1

  • 1Department of Neurology, West China Hospital Sichuan University Chengdu China.

Journal of the American Heart Association
|May 6, 2026
PubMed

Insights

Carotid artery dissection (CAD) shows distinct eye changes compared to carotid artery stenosis (CAS), with more retinal ischemia but increased choroidal blood flow. Retinal imaging can reveal these differences and risks.

Area of Science:

  • Ophthalmology
  • Neurology
  • Vascular Medicine

Background:

  • Carotid artery dissection (CAD) and carotid artery stenosis (CAS) are significant causes of stroke.
  • Understanding the distinct vascular alterations in the retina and choroid associated with CAD and CAS is crucial for diagnosis and risk stratification.
  • Associations between these oculovascular changes and patterns of cerebral infarction and stenosis severity require further investigation.

Purpose of the Study:

  • To compare retinal and choroidal vascular changes between patients with CAD and CAS.
  • To analyze the relationship between these vascular alterations and cerebral infarction patterns.
  • To assess the correlation between oculovascular findings and the severity of carotid artery stenosis or dissection.

Main Methods:

  • An observational study involving stenotic-degree-matched patients with CAD and CAS.
  • Evaluation of retinal ischemic signs (cotton wool spots, retinal artery occlusion, paracentral acute middle maculopathy) using optical coherence tomography/angiography.
  • Analysis of retinal vascular density and choroidal metrics including choriocapillaris density, thickness, vascular volume, and index.

Main Results:

  • Patients with CAD exhibited a significantly higher prevalence of paracentral acute middle maculopathy compared to CAS patients (6.4% vs. 0.61%).
  • Both CAD and CAS eyes showed reduced retinal vascular density, but CAD eyes had significantly higher choriocapillaris density, choroidal vascular volume, and thickness.
  • Retinal ischemic signs in CAD were associated with cerebral infarction and severe stenosis/occlusion, with specific retinal signs correlating with subcortical or cortical infarction patterns.

Conclusions:

  • Carotid artery dissection (CAD) presents a unique oculovascular phenotype with greater acute retinal ischemia and compensatory choroidal hyperperfusion compared to atherosclerotic stenosis (CAS).
  • Retinal imaging offers a noninvasive method to visualize CAD pathophysiology.
  • Oculovascular findings can serve as biomarkers for assessing hemodynamic stability and thromboembolic risk in patients with carotid artery disease.
Abstract

Keywords:
carotid artery dissectionchoroidal vesselsoptical coherence tomography angiographyretinal ischemic signretinal vessels

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