Assessment by fluorescein angiography of surgical treatment of occlusive carotid artery disease.

Abstract

Fundus fluorescein angiography was performed in 10 cases of occlusive carotid artery disease at presentation and after surgery or medical treatment. An improvement in the mlcrocirculation of the retina was observed in 4 cases after carotid endarterectomy and in 1 case after carotid endarterectomy and extracraniaMntracranial bypass. Improvement was not observed in 2 cases after extracranialintracranial bypass alone or in 3 cases in which surgical intervention was not undertaken. Our results suggest that carotid endarterectomy is a more effective procedure than extracranial-intracranial bypass in improving retinal perfusion when compromised by ipsilateral carotid obstruction. (Stroke 1987; 18:585-590) O cclusive disease of the carotid artery may produce ocular signs of retinal emboli, 1 chronic ocular ischemia, 2 neovascular glaucoma, 3 or venous-stasis retinopathy. 45 This latter term was used by Kearns and Hollenhorst for the combination of dilated veins, blossom-shaped hemorrhages, microaneurysms, and sludging of blood in the veins. Venousstasis retinopamy has been found in 12% of patients with unilateral carotid occlusion and 17% of patients with bilateral carotid occlusion. 6Fluorescein angiography is more sensitive than ophthalmoscopy in detecting minor microvascular abnormalities in the retina. Performing fluorescein angiography in patients with carotid occlusion or stenosis, we found abnormalities in 67% of cases. 7Fluorescein angiography may also be used in this group to assess whether carotid surgery improves retinal ischemia. This report reviews the findings of fluorescein angiography at diagnosis and follow-up in 10 patients with carotid occlusion or stenosis. Five patients had carotid artery surgery, 2 patients had extracranial-intracranial (EC-IC) anastomosis alone, and 3 patients had medical treatment only. Subjects and MethodsThese 10 cases may be considered in 4 groups depending on their management (Table 1). Two patients had superficial temporal-to-middle cerebral artery (ST-MCA) anastomosis alone (Group A), 1 patient had an external and internal carotid endarterectomy as well as a ST-MCA anastomosis (Group B), 4 patients had internal carotid endarterectomies (Group C), and 3 patients had medical treatment only (Group D).

Venous Stasis Retinopathy Unlikely Results from Internal Carotid Artery Obstruction Alone

“…Not only has their value in VSR never been proven, but also the rationale for these procedures cannot be derived from the assumption that carotid obstruction is the sole and only cause of VSR. The mere fact that fluo rescein angiography pictures improve docs not necessar ily imply clinical improvement as well [5]. At present, the only rationally feasible treatment is diligent treatment of vascular risk factors.…”

“…Later, internal carotid artery stenosis or occlusion was considered as the sole cause of the retinopathy, whereas, based on this presumed patho genesis, surgical procedures, such as extracranial-intracra nial bypass and carotid endarterectomy, have been pro posed to ameliorate retinal perfusion and thereby symp toms or at least progression of the disease [2][3][4][5][6].…”

Quantitative Optical Coherence Tomography Angiography Detects Retinal Perfusion Changes in Carotid Artery Stenosis

“…Color Doppler imaging can be used to detect reduction of blood flow in the ophthalmic artery and its improvement after surgical treatment (Mawn et al, 1997;Costa et al, 1999;Kawaguchi et al, 2002). Fluorescein angiography has been reported as a useful investigation to detect microvascular changes associated with CAS, although the invasive nature discourages its usage in patients without ocular symptoms (Choromokos et al, 1982;Sarkies et al, 1987;Terelak-Borys et al, 2012).…”

Chronic ocular ischemia and neovascular glaucoma: A result of extracranial carotid artery disease

“…4° When feasible, internal carotid endarterectomy provides the most durable and significant improvement in retinal artery and cerebral blood flOW. 36,41 Panretinal photocoagulation has been effective in short-term control of ocular ischemia when carotid endarterectomy or STA-MCA bypass is not possible or when the patient's medical condition does not allow immediate operation. 29,31 Although photocoagulation is the treatment of choice in neovascularization caused by diabetes or retinal vein occlusion, 42,43 it should only be considered as a temporizing maneuver with global ocular ischemia from carotid insufficiency.…”