Assessment of ocular perfusion after carotid endarterectomy with color-flow duplex scanning

Purpose: The purpose of this study was to assess the effect of carotid endarterectomy (CEA) on ocular perfusion with the measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) flow velocities with color-flow ocular duplex scanning (ODS). Ocular hemodynamics also were examined in a subset of patients with visual symptoms in an attempt to characterize the origin of the ocular symptoms and their response to surgery. Methods: Twenty-five patients with internal carotid artery stenoses (greater than or equal to 70%) underwent 29 CEAs. All the patients underwent ODS for the measurement of the peak systolic velocity (PSV) in the OA and the CRA of the ipsilateral eye before and after CEA. The preoperative and postoperative now velocities were compared in all the patients and in the patients with and without visual symptoms. Results: The preoperative PSV in the OA was 21.6 +/- 2.2 cm/s and in the CRA, was 7.7 0.7 cm/s. These values were reduced as compared with normative values (OA, 37.8 cm/s; CRA, 10.7 cm/s). After CEA, the PSV increased significantly in both vessels (postoperative OA, 38.6 +/- 2.5 cm/s, P < .0001; postoperative CRA, 12.1 +/- 0.9 cm/s, P = .0008). Fifteen of the 29 CEAs were performed for visual symptoms. The patients with ocular symptoms had significantly lower preoperative PSVs in the CRA as compared with those patients without visual symptoms (CRA with ocular symptoms, 6.5 +/- 0.8 cm/s; CRA with no ocular symptoms, 9.4 +/- 0.9 cm/s; P = .02). The PSV in the OA was not significantly lower in the patients with ocular symptoms. Eight patients (28%) were found to have reversed OA flow before surgery, but only three patients had ocular symptoms. All eight patients had normal antegrade flow in the OA after surgery. Conclusion: Severe carotid stenosis may be associated with reduced ocular perfusion, which can be quantitatively evaluated with ODS. Reduced OA and CRA flow velocities are corrected with successful CEA. The patients with ocular symptoms were observed to have significant reductions in CRA flow velocities. Reversed flow in the OA was not a marker for ocular symptoms in this study. ODS can identify global ocular ischemia and may be helpful in the evaluation of patients with atypical visual symptoms or with amaurosis fugax and no evidence of retinal emboli.