Journal of the American Heart Association · 2026
Retinal and Choroidal Vascular Alterations in Carotid Dissection Versus Atherosclerosis: Insights Into Divergent Ischemic Mechanisms.
СтатьяНаблюдательное исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Cao Le, Wang Hang, Shang Wenzuo, Kwapong William Robert, Liu Ruishan, Lan Tianxiang, Liu Guina, Hu Fayun, Wu Bo
Аннотация
BACKGROUND: To contrast retinal and choroidal vascular alterations between carotid artery dissection (CAD) and carotid artery stenosis (CAS), and analyze their associations with cerebral infarction patterns and stenosis severity.
METHODS: This observational study included stenotic-degree-matched patients with CAD and patients with CAS. Retinal ischemic signs-cotton wool spots, retinal artery occlusion, and paracentral acute middle maculopathy-were evaluated using fovea-centered optical coherence tomography/angiography. Retinal vascular density and choroidal metrics (choriocapillaris density, thickness, vascular volume, and index) were analyzed.
RESULTS: The final analysis included 863 eyes from 467 participants (85 with CAD, 274 with CAS, 108 controls). Patients with CAD showed a significantly higher prevalence of paracentral acute middle maculopathy than Patients with CAS (6.4% versus 0.61%, P<0.001). Although ipsilateral eyes in both groups showed reduced retinal vascular density (P<0.017), a divergent pattern was observed in the choroid: CAD-affected eyes demonstrated significantly higher choriocapillaris density, choroidal vascular volume, and choroidal thickness relative to both control and CAS-affected eyes (P<0.017). Clinically, retinal ischemic signs in CAD were significantly associated with cerebral infarction (P=0.022) and severe stenosis/occlusion (P=0.008). Notably, retinal signs correlated with cerebral infarction topography: subcortical infarctions were predominantly associated with paracentral acute middle maculopathy, whereas cortical infarctions were linked to cotton wool spots and retinal artery occlusion (P=0.004).
CONCLUSIONS: Compared with atherosclerotic stenosis, CAD exhibits a distinct oculovascular phenotype characterized by a higher burden of acute retinal ischemia but compensatory choroidal hyperperfusion. Retinal imaging serves as a noninvasive window into CAD pathophysiology, offering biomarkers for assessing hemodynamic stability and thromboembolic risk.
REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2300074640.
METHODS: This observational study included stenotic-degree-matched patients with CAD and patients with CAS. Retinal ischemic signs-cotton wool spots, retinal artery occlusion, and paracentral acute middle maculopathy-were evaluated using fovea-centered optical coherence tomography/angiography. Retinal vascular density and choroidal metrics (choriocapillaris density, thickness, vascular volume, and index) were analyzed.
RESULTS: The final analysis included 863 eyes from 467 participants (85 with CAD, 274 with CAS, 108 controls). Patients with CAD showed a significantly higher prevalence of paracentral acute middle maculopathy than Patients with CAS (6.4% versus 0.61%, P<0.001). Although ipsilateral eyes in both groups showed reduced retinal vascular density (P<0.017), a divergent pattern was observed in the choroid: CAD-affected eyes demonstrated significantly higher choriocapillaris density, choroidal vascular volume, and choroidal thickness relative to both control and CAS-affected eyes (P<0.017). Clinically, retinal ischemic signs in CAD were significantly associated with cerebral infarction (P=0.022) and severe stenosis/occlusion (P=0.008). Notably, retinal signs correlated with cerebral infarction topography: subcortical infarctions were predominantly associated with paracentral acute middle maculopathy, whereas cortical infarctions were linked to cotton wool spots and retinal artery occlusion (P=0.004).
CONCLUSIONS: Compared with atherosclerotic stenosis, CAD exhibits a distinct oculovascular phenotype characterized by a higher burden of acute retinal ischemia but compensatory choroidal hyperperfusion. Retinal imaging serves as a noninvasive window into CAD pathophysiology, offering biomarkers for assessing hemodynamic stability and thromboembolic risk.
REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2300074640.