Application of OCTA for Assessing Ocular Microvascular Effects of Carotid Endarterectomy: A Systematic Review

Abstract

BACKGROUND Carotid endarterectomy (CEA) is an established surgical procedure that restores cerebral blood flow in patients with carotid artery stenosis (CAS). Due to the intimate hemodynamic correlation between ocular and cerebral circulation, ocular blood flow changes in the retina and choroid after CEA have generated increasing interest. The purpose of the current systematic review was to assess the ocular micro vascular changes in patients treated with CEA, with particular emphasis on microvascular remodeling as evaluated using optical coherence tomography angiography (OCTA). MATERIALS AND METHODS Three electronic databases MEDLINE, Scopus, and Web of Science were used to search for studies assessing the occurrence of Ocular Vascular Effects in the postoperative setting of patients undergoing CEA, using OCTA. Assessment of studies' quality was performed using National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and cross-sectional studies. RESULTS Four prospective observational studies were included, with a total of 133 participants. The findings demonstrated significant increases in vessel density (VD) in the optic nerve head (ONH), peripapillary region, and deep capillary plexus (DCP) following CEA. Additionally, a notable reduction in choriocapillaris flow deficits (CC FD) in the 5-mm zone was observed. However, superficial capillary plexus (SCP) VD in the macular region showed no significant post-surgical changes, and choriocapillaris perfusion findings remained inconsistent across studies. CONCLUSION CEA is associated with improvements in ocular perfusion, particularly in the ONH, peripapillary region, and DCP, reinforcing the link between ocular and cerebrovascular circulation. These findings underscore the potential of OCTA as a non-invasive tool for postoperative vascular assessment and highlight the need for standardized imaging protocols and long-term studies to confirm its clinical utility.