Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment.
Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment.
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DOI：
10.1007/s11357-021-00392-4
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发表时间：
2021-08
期刊：
影响因子：
5.6
通讯作者：
Nagy ZZ
中科院分区：
文献类型：
--
作者：
István L;Czakó C;Élő Á;Mihály Z;Sótonyi P;Varga A;Ungvári Z;Csiszár A;Yabluchanskiy A;Conley S;Csipő T;Lipecz Á;Kovács I;Nagy ZZ
颈动脉狭窄（CAS）是影响西方世界老龄人口的全身性动脉粥样硬化疾病的结果。CAS通常与认知障碍有关。然而，与CAS相关的血管性认知功能障碍（VCI）的发展机制是多方面的，尚未完全了解。除了由于颈动脉粥样硬化病变引起的栓塞和血流量减少外，脑循环中的微循环功能障碍也在CAS相关的VCI中起关键作用。为了更好地了解微血管对CAS相关认知功能下降的贡献，并评估治疗干预的微血管保护作用，必须检查中枢神经系统（CNS）中微血管的结构和功能变化。然而，活体脑血管成像模式存在一些局限性。视网膜微血管为研究脑小血管病和VCI的发病机制提供了独特的机会，因为脑循环和视网膜循环具有相似的解剖学、生理学和胚胎学。类似的微血管病变可能出现在大脑和视网膜，因此眼部检查可以作为一种非侵入性的筛选工具，以研究与CAS相关的CNS的病理变化。在这篇综述中，CAS的眼部体征和CAS相关的微血管功能障碍的视网膜表现进行了讨论。讨论了能够成像眼循环的方法（包括眼底镜、荧光素血管造影、多普勒超声、光学相干断层扫描[OCT]和光学相干断层扫描血管造影[OCTA]）的优点和局限性。动态视网膜血管分析（DVA）的潜在用途，它允许直接可视化的神经血管耦合反应在中枢神经系统中，了解微血管的贡献，在CAS患者的认知能力下降也被考虑。
Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.
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DOI：
10.1056/nejmoa0912321
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brott TG;Hobson RW 2nd;Howard G;Roubin GS;Clark WM;Brooks W;Mackey A;Hill MD;Leimgruber PP;Sheffet AJ;Howard VJ;Moore WS;Voeks JH;Hopkins LN;Cutlip DE;Cohen DJ;Popma JJ;Ferguson RD;Cohen SN;Blackshear JL;Silver FL;Mohr JP;Lal BK;Meschia JF;CREST Investigators
通讯作者：
CREST Investigators
影响因子：
8.3
作者：
de Weerd M;Greving JP;Hedblad B;Lorenz MW;Mathiesen EB;O'Leary DH;Rosvall M;Sitzer M;Buskens E;Bots ML
通讯作者：
Bots ML
DOI：
10.3129/i08-056
发表时间：
2008-06-01
影响因子：
4.2
作者：
Flammer, Josef;Mozaffarieh, Maneli
通讯作者：
Mozaffarieh, Maneli
影响因子：
9.9
作者：
Brisset, Marion;Boutouyrie, Pierre;Debette, Stephanie
通讯作者：
Debette, Stephanie
DOI：
10.4274/tjo.84565
发表时间：
2017-12-01
影响因子：
1.1
作者：
Cakir, Akin;Duzgun, Eyup;Unal, Melih Hamdi
通讯作者：
Unal, Melih Hamdi