{"title":"颈动脉内膜切除术与支架置入术对颈动脉狭窄患者视力恢复的影响。","authors":"Soichi Oya, Shinsuke Yoshida, Akira Saito, Satoshi Iihoshi, Hiroto Obata, Atsushi Yamasaki, Takahiro Koizumi, Masaaki Shojima, Kaima Suzuki, Hidetoshi Ooigawa, Shinya Kohyama, Yuichiro Kikkawa, Hiroki Kurita","doi":"10.1227/neu.0000000000003379","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"472-480"},"PeriodicalIF":3.9000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative Effects of Carotid Endarterectomy and Stenting on Visual Recovery in Patients With Carotid Artery Stenosis.\",\"authors\":\"Soichi Oya, Shinsuke Yoshida, Akira Saito, Satoshi Iihoshi, Hiroto Obata, Atsushi Yamasaki, Takahiro Koizumi, Masaaki Shojima, Kaima Suzuki, Hidetoshi Ooigawa, Shinya Kohyama, Yuichiro Kikkawa, Hiroki Kurita\",\"doi\":\"10.1227/neu.0000000000003379\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":19276,\"journal\":{\"name\":\"Neurosurgery\",\"volume\":\" \",\"pages\":\"472-480\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-02-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/neu.0000000000003379\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003379","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：尽管颈动脉内膜切除术（CEA）和颈动脉支架植入术（CAS）降低了卒中的风险，但其改善视力下降的效果尚不清楚。本研究旨在评价CEA和CAS对颈动脉狭窄患者眼血流量（OBF）和视力（VA）的影响，同时探讨术后微栓塞与视力恢复的可能相关性。方法：78例手术结果(CEA， 39例；对76例颈动脉狭窄患者行CAS， 39)手术进行前瞻性分析。OBF测量采用激光散斑血流成像评估平均模糊比，反映绝对视网膜血流量。使用测量对比敏感度的Contrast Sensitivity Vision-1000评估VA，并计算对数对比敏感度函数下的面积（AULCSF）作为VA的度量。术后立即使用磁共振成像评估微栓塞，并使用中央中央凹光学相干断层扫描评估其对视网膜血管的影响。结果：两种治疗均显著提高CEA的OBF (MBR: 31.4 ~ 37.9 [P < 0.0001])；33.9 ~ 37.8 [P = .007])。CEA后VA显著改善（AULCSF: 1.03 ~ 1.06, P = 0.02），而CAS后VA无显著改善（AULCSF: 1.08 ~ 1.06, P = 0.37）。在所有78例患者的分析中，术后微栓塞患者的视力改善较差（AULCSF变化0.01 vs -0.07, P = 0.01）。此外，在39例进行光学相干断层扫描评估的患者中，CAS后视网膜血管密度下降明显高于CEA （-0.5 vs 1.1, P = 0.04）。结论：颈动脉血运重建术虽能改善OBF，但仅能改善CEA后的VA。微栓塞似乎会损害视力恢复。这些发现强调了评估颈动脉狭窄患者视觉功能的重要性，以及基于个人视觉特征和卒中风险的个性化治疗方法的必要性。
Comparative Effects of Carotid Endarterectomy and Stenting on Visual Recovery in Patients With Carotid Artery Stenosis.
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.
期刊介绍：
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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