CLINICAL FINDINGS AND HEMODYNAMIC-CHANGES ASSOCIATED WITH SEVERE OCCLUSIVE CAROTID-ARTERY DISEASE

Objective: The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease ( OCAD) by means of color Doppler imaging (CDI). Design: A case-controll ed study. Participants: Fifty-six consecutive patients with severe OCA D and an age- and sex-matched control group consisting of 56 healthy p atients without OCAD were studied. Intervention: All 112 patients unde rwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator. Main Outcome Mea sures: Peak systolic velocity, end diastolic velocity, and the resisti ve index of the ophthalmic, central retinal, and temporal short poster ior ciliary arteries were measured. The authors compared the hemodynam ic parameters measured in patients with severe OCAD with those obtaine d in the control group. The hemodynamic parameters of patients with as ymmetric OCAD (stenosis > 70% in one internal carotid artery and steno sis < 50% in the contralateral artery) were also compared. In an attem pt to determine risk factors associated with the ocular ischemic syndr ome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS. Results: Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the centra l retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Young er age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carot id stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.03 8) were significant risk factors for OIS. Conclusions: Patients with s evere OCAD show hemodynamic changes that suggest reduced retrobulbar b lood flow. Patients with severe bilateral OCAD, high-grade carotid ste nosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.