Carotid endarterectomy for acute ocular ischemia
AbstractTreatment effectiveness among patients with carotid artery stenosis and acute visual impairment was studied. The 1st surgical group (carotid endarterectomy) included 49 people, the 2nd group of conservative treatment included 50 people. All patients underwent examination. Visual acuity was determined. Autorefractometry, ophthalmoscopy, and perimetry were performed. The functional state of the optic nerve and ultrasound duplex scanning of eye arteries and carotid arteries were assessed.
Control points: initial state of visual organ function, state 1 month and 1 year after surgery or a course of conservative treatment.
Results. The events of amaurosis, if such, disappeared in all patients after surgery and only in 3 after conservative therapy (p<0.001), the visual fields expanded in 16 after carotid artery reconstruction and in none after conservative treatment (p<0.001), the functional state of the optic nerve improved in 16 patients after surgery and did not undergo changes in those treated conservatively (p<0.001), the systolic blood flow rate in the arteries of the eye became 30% higher after surgery and remained the same after conservative treatment. In patients with occlusion of the central retinal artery and its branches, visual acuity improved in 8 vs 1, respectively (p=0.005), visual fields expanded in 6 vs 2 (p=0.112). Improvements in the functional state of the optic nerve were particularly meaningful: 14 vs 0 (p<0.001), in patients after surgery, there was a 40% increase in the systolic blood flow rate in the arteries of the eye, whereas after conservative therapy, no such effect was observed. In patients with acute ischemic neuropathy, an improvement in visual acuity was recorded in 9 cases of the surgical group and in 2 patients of the conservative-treatment group (p<0.001), expansion of visual fields was achieved in 9 patients of the surgical group versus 3 in the conservatively treated group (p=0.004), and the functional state of the optic nerve improved in 11 vs 0, respectively (p<0.001). After carotid endarterectomy the ratio of neurologically asymptomatic and symptomatic patients significantly changed – 22/27 vs 41/8 (p=0.0001), whereas after conservative therapy, no such changes in the neurological status were found – 23/27 vs 19/29 (p=0.6617). Only in 2nd group there were 2 deaths from ischemic stroke.
Conclusion. Carotid endarterectomy not only effectively and safely helps to avoid cerebral ischemia, but also reliably improves visual functions in patients with carotid artery stenosis and acute visual impairment.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Gavrilenko A.V., Kuklin A.V., Kiseleva T.N.; data collection and handling, statistical processing, draft manuscript preparation – Kiseleva T.N., Kuklin A.V.; manuscript revision – Kuklin A.V.
For citation: Gavrilenko A.V., Kuklin A.V., Kiseleva T.N. Carotid endarterectomy for acute ocular ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 122–30. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-122-130
Keywords:carotid endarterectomy; amaurosis fugax; visual acuity; retinal artery occlusion
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