Clinical Findings and Hemodynamic Changes Associated with Severe Occlusive Carotid Artery Disease

Costa, Vital Paulino; Kuzniec, Sérgio; Molnar, Laszlo J.; Cerri, Giovanni Guido; Puech-Leão, Pedro; Carvalho, Cláudio Antonio Ferraz de

doi:10.1016/s0161-6420(97)30066-9

Cited by 80 publications

(49 citation statements)

References 32 publications

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“…Some studies found an association between chronic ocular ischemia and reversal of flow in the OphthA and between chronic ocular ischemia and reduction of retrobulbar blood flow. [17][18][19] Another study could not confirm these associations. 20 Our findings suggest that in patients with CAO the hemodynamic state of the brain may be an important indicator of the development of VSR.…”

Section: Discussionmentioning

confidence: 89%

Venous Stasis Retinopathy in Symptomatic Carotid Artery Occlusion

Klijn

Kappelle

Schooneveld

et al. 2002

Stroke

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Background and Purpose-Chronic ocular ischemia is a rare form of ischemia of the eye in patients with carotid artery occlusion (CAO). The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR). The aim of this study was to gain insight into the prevalence, cause, and outcome of VSR in patients with symptomatic CAO. Methods-In 110 patients with symptomatic CAO, we prospectively investigated the frequency of VSR, the association between the presence of VSR and impaired cerebral blood flow, and the proportion of patients who developed clinically manifest chronic ocular ischemia with ischemia of the anterior eye segment or blindness. Results-At study entry, VSR was found in 32 patients (29%; 95% CI, 21 to 38), particularly in those with symptoms classically associated with a hemodynamic cause, such as limb shaking (relative risk, 2.4; 95% CI, 1.0 to 5.9). Patients with VSR had lower pulsatility indexes in the ophthalmic artery in case of reversed flow, lower cerebral CO 2 reactivity, and lower cerebropetal blood flow than patients without VSR. On follow-up (mean, 29 months), clinically manifest chronic ocular ischemia developed in 4 patients (annual rate, 1.5%; 95% CI, 0.4 to 3.8); it tended to occur more often in patients in whom VSR was present at study entry (relative risk, 7.3; 95% CI, 0.8 to 68). Conclusions-One

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Section: Discussionmentioning

confidence: 89%

Venous Stasis Retinopathy in Symptomatic Carotid Artery Occlusion

Klijn

Kappelle

Schooneveld

et al. 2002

Stroke

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“…Em um estudo de Costa et al (7) , a média de estenose da artéria carótida em pacientes com SOI (96,2 ± 6,1%) foi significativamente maior que em pacientes com doença oclusiva severa da artéria carótida sem SOI (87,2 ± 8,2%). A ocorrência de estenose bilateral severa (>70%) foi mais freqüente em pacientes com SOI, sugerindo que o fluxo na artéria carótida interna contralateral pode ser importante para compensar a redução do fluxo sangüíneo ispsilateral (via polígono de Willis).…”

Section: Discussionunclassified

“…Uma alta incidência de fluxo reverso na artéria oftálmica tem sido encontrada em pacientes com SOI, variando entre 66,7 e 83,3% (10) . Costa et al observaram que pacientes com estenose carotídea severa bilateral, fluxo reverso na artéria oftálmica e com alto grau de estenose da carótida interna apresentam maior risco de desenvolver SOI (7) . A associação entre fluxo reverso na artéria oftálmica e SOI é explicada graças a um fenômeno de "roubo", caracterizado por um "shunt" com o circuito intracraniano de baixa resistência e redução do fluxo sangüíneo retrobulbar (11) .…”

Section: Discussionunclassified

Síndrome ocular isquêmica associada a glaucoma neovascular: relato de um caso

Arcieri

Costa

2001

Arq. Bras. Oftalmol.

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Síndrome ocular isquêmica associada a glaucoma neovascular: relato de um casoOs autores apresentam um caso de glaucoma neovascular secundário à síndrome ocular isquêmica como manifestação inicial de doença oclusiva de artérias carótidas. O exame de Doppler colorido das carótidas e órbitas mostrava presença de todos os fatores associados a um maior risco de desenvolver a síndrome: estenose carotídea grave bilateral, alto grau de estenose da artéria carótida interna e fluxo reverso na artéria oftálmica. Os autores discutem o fato do glaucoma neovascular ter sido controlado com apenas uma medicação tópica. INTRODUÇÃOA síndrome ocular isquêmica (SOI) resulta de uma hipoperfusão ocular prolongada causada por uma grande estenose ou oclusão da artéria caróti-da interna extracranial ou da artéria carótida comum. Geralmente acomete indivíduos do sexo masculino e com mais de 50 anos de idade (1)(2) , associando-se freqüentemente a alterações sistêmicas severas e alta taxa de mortalidade, com envolvimento bilateral em 20% dos casos (2) . A SOI é caracterizada por manifestações no segmento anterior, incluindo dilatação das veias episclerais, edema corneano, células e "flare" na câmara anterior, pupila em meia midríase e pouco reagente, catarata e neovascularização de íris e ângulo. As manifestações no segmento posterior incluem dilatação venosa, hemorragias intrarretinianas em média periferia e microaneurismas, neovascularização do disco e/ou retina, estreitamento arteriolar, tortuosidade vascular e edema macular (3) . Alguns pacientes relatam dor constante localizada na região orbitária, que irradia anteriormente, piora quando a cabeça é elevada e melhora quando é abaixada.Há desenvolvimento de glaucoma neovascular em 35% dos casos (2) , embora em alguns pacientes o valor da pressão intra-ocular (PIO) permaneça dentro dos limites da normalidade ou até mesmo reduzido, apesar do fechamento angular completo. O objetivo deste relato é apresentar um caso de SOI que foi submetido à investigação com Doppler colorido e apresentou glaucoma neovascular controlado com medicação tópica. RELATO DE CASOPaciente de sexo masculino, branco, 77 anos, queixava-se de dor e hiperemia conjuntival em OD há 1 dia, com piora da acuidade visual (AV) há RELATOS DE CASOS

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“…Arterial stenosis from the distal site of the internal carotid artery to OA, however, could not be confirmed. Laterality, reduced or reversed flow of OA, which suggests ocular ischemic syndrome, 26 28 The severity of diabetic retinopathy is closely linked to the Sm/Dm ratio in OA Doppler flow. 10 Further comparative studies are needed to elucidate the relationship between the findings of ocular fundus and OA Doppler flow that may be highly suggestive of systemic atherosclerosis.…”

Section: Study Limitationmentioning

confidence: 99%

Waveform of Ophthalmic Artery Doppler Flow Predicts the Severity of Systemic Atherosclerosis

Maruyoshi

Kojima

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary artery disease (CAD) is a life-threatening condition that encompasses systemic atherosclerosis. Many basic-research, epidemiological, and clinical studies have been conducted with the aim of combating atherosclerotic disease. Together with aging, the progression of atherosclerosis leads to an increase in stiffening of the aorta, and in turn an increase in pulse pressure (PP) through a reduction in arterial compliance and increased pulse wave velocity. 1 Therefore, increased PP is considered as a sign of increased arterial stiffness. Elevated PP and decreased arterial compliance are also recognized as risk factors for CAD. 1,2Indices of intrarenal vascular resistance calculated from pulsed-wave Doppler velocities, such as pulsatility index (PI) and resistive index (RI), correlate positively with PP and negatively with the carotid hemodynamic pattern in patients with essential hypertension. 3 This pattern was determined by calculating the ratio of diastolic to systolic mean velocity in pulsed Doppler flow recordings of the common carotid artery. The same ratio also showed a significant negative correlation with PP and carotid arterial stiffness. 4 These findings suggest that hemodynamic Doppler flow patterns may reflect not only peripheral vascular resistance but also systemic arterial stiffness.The ophthalmic artery (OA) is the first major branch of the internal carotid artery and divides into many branches in the orbital area. Doppler imaging of the OA was recently made possible by improvements in Doppler equipment. 5 Changes in OA blood flow assessed on pulsed Doppler (OA Doppler) have provided new insights into various vascular disorders including ophthalmic diseases, carotid artery stenosis, and diabetes mellitus. 5 OA Doppler has particular anatomical advantages due to the absence of ultrasonic obstacles and the vertical angle, which differs from the parallel-signaling of carotid artery Doppler to the transducer. Such findings in the ocular fundus are associated closely with systemic atherosclerosis, with previous reports showing that atherosclerotic changes in retinal arteries are potential markers of systemic cardiovascular disease. 6,7 OA Doppler flow patterns may also reflect the severity of diabetes retinopathy. 8,9 Fukuda et al showed that the ratio of systolic to diastolic mean velocity in OA Doppler is closely involved in age and the severity of diabetic retinopathy. 10 There is little information on the relationship between OA Doppler flow and systemic atherosclerosis. We hypothesized Background: Doppler imaging of ophthalmic artery (OA), the first major branch of the internal carotid artery, provides anatomical advantages due to the vertical angle to the body surface and absence of ultrasonic obstacles. It was hypothesized that the Doppler waveform indices of OA correlate with severity of systemic atherosclerosis.

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Clinical Findings and Hemodynamic Changes Associated with Severe Occlusive Carotid Artery Disease

Cited by 80 publications

References 32 publications

Venous Stasis Retinopathy in Symptomatic Carotid Artery Occlusion

Venous Stasis Retinopathy in Symptomatic Carotid Artery Occlusion

Síndrome ocular isquêmica associada a glaucoma neovascular: relato de um caso

Waveform of Ophthalmic Artery Doppler Flow Predicts the Severity of Systemic Atherosclerosis

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