=Retinal ischemic perivascular lesions are associated with increased carotid artery stenotic degree.

Purpose: Retinal ischemic perivascular lesions (RIPLs) have been reported as potential biomarkers for cardiovascular diseases and stroke. We aimed to investigate the RIPLs in carotid artery stenosis (CAS) patients and their association with stenotic degree.

Methods: Patients with unilateral CAS or carotid artery occlusion were recruited. Optical coherence tomography (OCT) was conducted for assessing the presence, number, and distribution of RIPLs. OCT angiography (OCTA) was used for evaluating microvascular density in superficial vascular complex (SVC) and deep vascular complex (DVC).

Results: Eighty hundred and fifty-four eyes from 474 CAS patients were included. Ipsilateral eyes had more PRILs compared to contralateral eyes (all p < 0.01). CAS patients with cerebral infarction had a higher incidence and broader distribution of RIPLs compared to those without infarction (both p <0.05). The presence, number, and distribution of RIPLs were positively associated with stenotic degree (all p < 0.001). Eyes with RIPLs had lower SVC density (p = 0.020) compared to eyes without RIPLs.

Conclusions: RIPLs are anatomical markers of ischemia and are suggested to be associated with cerebral infarction and stenotic degree in CAS patients. OCT/OCTA is a noninvasive tool to detect retinal ischemic changes and quantitatively measure retinal microvascular changes in CAS patients.