{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:30:47Z","timestamp":1760059847343,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This study aimed to prospectively assess the incidence of retinal embolization and to evaluate the vascular and structural changes in the retina and choroid in 52 patients with asymptomatic severe carotid artery disease who underwent carotid artery revascularization. Methods: In our study, 35 patients underwent carotid endarterectomy (CEA) and 17 underwent carotid artery stenting (CAS). Biomicroscopy, fundoscopy, optical coherence tomography (OCT), and OCT-angiography (OCTA) were performed at baseline and 1 month after revascularization. Results: The subfoveal choroidal thickness (SFCT), peripapillary choroidal thickness inferior to the optic nerve head (ppCTi), total overall average retinal vascular density (rVDtot), and total overall average choriocapillaris vascular density (ccVDtot) of the eyes ipsilateral to the operated carotid artery increased significantly after revascularization, whereas a statistically significant increase was also found in the SFCT, rVDtot, and ccVDtot of the contralateral eyes in the overall cohort. Comparing the two study groups, we found that the SFCT, superior and inferior peripapillary choroidal thicknesses (ppCTs, ppCTi), rVDtot, and ccVDtot increased in both groups after revascularization, but significantly only in the CEA group. Furthermore, the temporal choriocapillaris vascular density (ccVDt) increased significantly after revascularization in both groups to a similar degree. Conclusions: Carotid artery revascularization led to a statistically significant increase in retinal and choroidal vascular densities, which indicates significantly improved ocular perfusion. The analysis of the findings of the two study groups suggests the superiority of CEA in terms of improving ocular perfusion in asymptomatic severe carotid artery disease. The rate of retinal embolization was similar in both surgical groups.<\/jats:p>","DOI":"10.3390\/diagnostics15141826","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T07:56:14Z","timestamp":1753084574000},"page":"1826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ocular Structural and Vascular Changes in Patients with Severe Asymptomatic Carotid Disease After Undergoing Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS)"],"prefix":"10.3390","volume":"15","author":[{"given":"Foteini","family":"Xanthou","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2780-0062","authenticated-orcid":false,"given":"Anna","family":"Dastiridou","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Giannoukas","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miltiadis","family":"Matsagkas","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3242-9066","authenticated-orcid":false,"given":"Chara","family":"Tzavara","sequence":"additional","affiliation":[{"name":"Biostatistics Department, National and Kapodistrian University of Athens, 15784 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Chaidoulis","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5303-7793","authenticated-orcid":false,"given":"Sofia","family":"Androudi","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6514-6559","authenticated-orcid":false,"given":"Evangelia E.","family":"Tsironi","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1001\/jama.2022.4835","article-title":"Incidence of Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention","volume":"327","author":"Chang","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s11936-017-0564-0","article-title":"Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy?","volume":"19","author":"Wabnitz","year":"2017","journal-title":"Curr. Treat Options Cardiovasc. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S0140-6736(10)61197-X","article-title":"Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial","volume":"376","author":"Halliday","year":"2010","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/00055735-199712000-00004","article-title":"Carotid disease and the eye","volume":"8","author":"Biousse","year":"1997","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Biousse, V., and Newman, N.J. (2008). Eye syndromes and the neuro-ophthalmology of stroke. Handbook of Clinical Neurology, Elsevier.","DOI":"10.1016\/S0072-9752(08)93029-3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/00055735-200206000-00002","article-title":"Retinal arteriolar emboli: Epidemiology and risk of stroke","volume":"13","author":"Wong","year":"2002","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.jocn.2015.01.033","article-title":"Retinal embolization after carotid endarterectomy and stenting for carotid artery stenosis","volume":"22","author":"Song","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/1708538119858258","article-title":"Asymptomatic carotid stenosis and concomitant silent brain infarctions","volume":"28","author":"Rudolph","year":"2020","journal-title":"Vascular"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100951","DOI":"10.1016\/j.preteyeres.2021.100951","article-title":"Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)","volume":"84","author":"Wang","year":"2021","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.4103\/IJO.IJO_2537_22","article-title":"Evaluation of optical coherence tomography angiography changes in nonarteritic anterior ischemic optic neuropathy","volume":"71","author":"Phuljhele","year":"2023","journal-title":"Indian. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s00701-017-3092-5","article-title":"The maxillary artery and its variants: An anatomical study with neurosurgical applications","volume":"159","author":"Alvernia","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_12","first-page":"591961","article-title":"Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications","volume":"2015","author":"Michalinos","year":"2015","journal-title":"Anat. Res. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1136\/neurintsurg-2017-013193","article-title":"Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow","volume":"10","author":"Sadato","year":"2018","journal-title":"J. Neurointerv Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lahme, L., Marchiori, E., Panuccio, G., Nelis, P., Schubert, F., Mihailovic, N., Torsello, G., Eter, N., and Alnawaiseh, M. (2018). Changes in retinal flow density measured by optical coherence tomography angiography in patients with carotid artery stenosis after carotid endarterectomy. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-35556-4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/02713683.2019.1666994","article-title":"Structural Analysis of the Retina and Choroid before and after Carotid Artery Surgery","volume":"45","author":"Ercan","year":"2020","journal-title":"Curr. Eye Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1469-7580.2005.00395.x","article-title":"Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: A rationale based on homology between cerebral and retinal microvasculatures","volume":"206","author":"Patton","year":"2005","journal-title":"J. Anat."},{"key":"ref_17","first-page":"5296048","article-title":"Evaluation of Subfoveal Choroidal Thickness in Internal Carotid Artery Stenosis","volume":"2016","author":"Bozkurt","year":"2016","journal-title":"J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3928\/23258160-20150213-20","article-title":"A quantitative evaluation of the posterior segment of the eye using spectral-domain optical coherence tomography in carotid artery stenosis: A pilot study","volume":"46","author":"Sayin","year":"2015","journal-title":"Ophthalmic Surg. Lasers Imaging Retina"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s10792-020-01642-8","article-title":"Investigation of macular and optic nerve head structural changes using spectral domain optical coherence tomography in internal carotid artery stenosis","volume":"41","author":"Dagdelen","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1177\/0003319717737223","article-title":"Changes in Ocular Subfoveal Choroidal Thickness After Carotid Endarterectomy Using Enhanced Depth Imaging Optical Coherence Tomography: A Pilot Study","volume":"69","author":"Lareyre","year":"2018","journal-title":"Angiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5935\/0004-2749.20200081","article-title":"Ocular blood flow and choroidal thickness changes after carotid artery stenting","volume":"83","author":"Biberoglu","year":"2020","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, C.W., Cheng, H.C., Chang, F.C., and Wang, A.G. (2019). Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-51382-8"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/aos.14648","article-title":"Subfoveal choroidal thickness in ipsi- and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy: A prospective study","volume":"99","author":"Koskinen","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/ene.12038","article-title":"Reversal of ophthalmic artery flow as a predictor of intracranial hemodynamic compromise: Implication for prognosis of severe carotid stenosis","volume":"20","author":"Tsai","year":"2013","journal-title":"Eur. J. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2530914","DOI":"10.1155\/2016\/2530914","article-title":"Relationship between the Direction of Ophthalmic Artery Blood Flow and Ocular Microcirculation before and after Carotid Artery Stenting","volume":"2016","author":"Ishii","year":"2016","journal-title":"J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"He\u00dfler, H., Zimmermann, H., Oberwahrenbrock, T., Kadas, E.M., Mikolajczak, J., Brandt, A.U., Kauert, A., Paul, F., and Schreiber, S.J. (2015). No Evidence for Retinal Damage Evolving from Reduced Retinal Blood Flow in Carotid Artery Disease. Biomed. Res. Int., 2015.","DOI":"10.1155\/2015\/604028"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00117-024-01331-y","article-title":"Die Rolle der Duplexsonographie der Arteria ophthalmica bei Stenosen der Arteria carotis interna [Role of duplex ultrasonography of the ophthalmic artery in internal carotid artery stenosis]","volume":"64","author":"Schappe","year":"2024","journal-title":"Radiologie"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Xu, Q., Sun, H., and Yi, Q. (2022). Association Between Retinal Microvascular Metrics Using Optical Coherence Tomography Angiography and Carotid Artery Stenosis in a Chinese Cohort. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.824646"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/tvst.13.8.5","article-title":"Influence of Carotid Artery Stenting on the Retina and Choroid","volume":"13","author":"Cao","year":"2024","journal-title":"Transl Vis Sci Technol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.preteyeres.2017.11.003","article-title":"Optical coherence tomography angiography","volume":"64","author":"Spaide","year":"2018","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102748","DOI":"10.1016\/j.pdpdt.2022.102748","article-title":"Early choroidal structure and choroidal vascularity index change after carotid stenting","volume":"38","author":"Durusoy","year":"2022","journal-title":"Photodiagnosis Photodyn. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8438","DOI":"10.1167\/iovs.11-8108","article-title":"Subfoveal choroidal thickness in relation to sex and axial length in 93 Danish university students","volume":"52","author":"Li","year":"2011","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ophtha.2012.07.048","article-title":"Subfoveal choroidal thickness: The Beijing Eye Study","volume":"120","author":"Wei","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1007\/s11357-021-00392-4","article-title":"Imaging retinal microvascular manifestations of carotid artery disease in older adults: From diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment","volume":"43","author":"Varga","year":"2021","journal-title":"Geroscience"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1038\/nrn2283","article-title":"Evolution of the vertebrate eye: Opsins, photoreceptors, retina and eye cup","volume":"8","author":"Lamb","year":"2007","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/tp.2012.150","article-title":"Retinal vascular biomarkers for early detection and monitoring of Alzheimer\u2019s disease","volume":"3","author":"Frost","year":"2013","journal-title":"Transl. Psychiatry"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1826\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:03Z","timestamp":1760033583000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":36,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141826"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141826","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}