Cortical blindness after left internal mammary artery to left anterior descending coronary artery graft angiograph

Abstract

We describe a case of transient cortical blindness following internal mammary artery to left anterior descending coronary artery graft angiography. This dramatic, infrequent, and self-limiting complication so far has not been described in the cardiovascular literature. In the present era of internal mammary artery use for the left coronary artery grafting, the angiographer should be familiar with the diagnosis, prevention, and management of complications previously seen mostly during the posterior cerebral circulation angiography.

A Case of Transient Loss of Vision Following Coronary Angiography: Etiology, Investigation and Management

“…The British Cardiac Society has reported an incidence of 0.06% [1] and the National Institutes of Health in the United States of America that of 0.03% [2]. These are thus rare complications, considering the widespread, frequent, performance of coronary angiography.…”

“…Cortical blindness is better recognized as a complication of cerebral and in particular vertebral angiography having an incidence thereafter of 0.3-2.6% [2] but has also already been described after coronary angiography. Fischer-Williams et al reported one case in 12,367 coronary angiographies, an incidence of 0.008% [3] and Kinn et al reported three cases in over 6,000 such procedures, an incidence of 0.05% [4].…”

Cortical Blindness: A Rare but Dramatic Complication following Coronary Angiography

“…In 3 cases [5], reexposure did not lead to recurrence of CB. In contrast, 1 patient [4] developed CB again. Thus, patients with CB following previous contrast medium exposure may be at increased risk of developing CB at re-exposure.…”

“…CB after coronary angiography was reported following both high-osmolality ionic [1,2] and modern low-osmolality non-ionic contrast agents [3][4][5][6][7]. The incidence and duration of blindness seem to be unrelated to the dose of contrast medium applied.…”

“…The majority of the patients had previously been exposed to dye without developing any neurological symptoms. Four patients with a history of CB were re-exposed to contrast medium within a few months [4,5]. They were pretreated with corticosteroids, and a relatively small amount of contrast agent was given (80-180 ml).…”