# Retinal Ischemic Perivascular Lesions Are Associated with Cardiovascular Diseases in Patients with Severe Carotid Artery Stenosis

## TL;DR

This study finds that retinal ischemic perivascular lesions are linked to cardiovascular disease in patients with severe carotid artery stenosis.

## Contribution

The novel contribution is identifying RIPLs as a potential biomarker for cardiovascular disease in SCAS patients.

## Key findings

- Patients with CVD had lower vessel density and altered retinal thickness compared to those without CVD.
- RIPLs were more prevalent in patients with CVD (55.7%) than in those without (30.6%).
- Bilateral RIPLs showed the strongest association with CVD (OR = 7.383).

## Abstract

Background/Objectives: The objective of this study is to evaluate the association between retinal ischemic perivascular lesions (RIPLs) and cardiovascular diseases (CVDs) among patients diagnosed with severe carotid artery stenosis (SCAS). Methods: Consecutive patients (123 patients) with SCAS were included and underwent swept-source optical coherence tomography angiography (SS-OCTA). Retinal structural and blood flow parameters of the macular region were calculated and compared between patients with and without CVD. The prevalence of RIPLs confirmed on B-scan images was compared between patients with and without CVD. The relationship between RIPLs and CVD in patients with SCAS was explored using multivariate logistic regression analysis. Subgroup analysis was conducted to evaluate the relationship between ipsilateral RIPLs, contralateral RIPLs, and bilateral RIPLs and CVD. Results: Of the 123 patients with SCAS, 61 patients (49.6%) had a history of CVD. The CVD group had lower vessel density in the superficial and deep retinal vascular complexes, thinner inner retinal thickness, and thicker outer retinal thickness compared with the non-CVD group. A higher prevalence of RIPLs was found in the CVD group compared to the non-CVD group (55.7% vs. 30.6%, p = 0.006). The presence of RIPLs was significantly associated with CVD in SCAS patients (OR = 3.953 [1.695–9.219], p = 0.001) after adjusting for covariates. Subgroup analysis revealed greatest risk of bilateral RIPLs for CVD (OR = 7.383 [1.749–30.393], p = 0.006), followed by contralateral RIPLs (OR = 4.024 [1.432–11.306], p = 0.008) and ipsilateral RIPLs (OR = 2.951 [1.258–6.921], p = 0.013). Conclusions: The presence of RIPLs is significantly associated with CVD in SCAS patients. Findings of this research demonstrated that evaluation of RIPLs may help identify high-risk SCAS patients and facilitate special medical care for this group of patients.