Comparative Effects of Carotid Endarterectomy and Stenting on Visual Recovery in Patients With Carotid Artery Stenosis.

Abstract

Background and objectives: Although carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke, their efficacy in improving decreased vision is unclear. This study aims to evaluate the effects of CEA and CAS on ocular blood flow (OBF) and visual acuity (VA) in patients with carotid artery stenosis, while also exploring the possible relevance of postoperative microembolisms to visual recovery.

Methods: The results of 78 procedures (CEA, 39; CAS, 39) performed in 76 patients with carotid artery stenosis were prospectively analyzed. OBF was measured using laser speckle flowgraphy to assess the mean blur ratio, which reflects the absolute retinal blood flow. VA was assessed using Contrast Sensitivity Vision-1000, which measures contrast sensitivity, and the area under the log contrast sensitivity function (AULCSF) was calculated as a measure of VA. Microembolisms were evaluated using magnetic resonance imaging immediately after surgery, and their effects on retinal vessels were assessed using optical coherence tomography of the central fovea.

Results: Both treatments significantly enhanced OBF (MBR: 31.4 to 37.9 [P < .0001] for CEA; 33.9 to 37.8 [P = .007] for CAS). VA improved significantly after CEA (AULCSF: 1.03 to 1.06, P = .02), but not after CAS (1.08 vs 1.06, P = .37). In the analysis of all 78 patients, those with postoperative microembolisms showed poorer visual improvement (AULCSF change 0.01 vs -0.07, P = .01). In addition, among 39 patients assessed with optical coherence tomography, retinal vessel density decreased significantly more after CAS than CEA (-0.5 vs 1.1, P = .04).

Conclusion: Although carotid revascularization can enhance OBF, VA improved only after CEA. Microembolisms appear to impair visual recovery. These findings emphasize the importance of assessing visual function in patients with carotid artery stenosis and the need for personalized treatment approaches based on individual visual profiles and stroke risk.