Orbital infarction syndrome after mechanical thrombectomy in acute ischaemic stroke

Abstract

Orbital infarction syndrome (OIS) encompasses the ischaemic infarction of all intraorbital and intraocular structures (optic nerve, extraocular muscles and orbital fat) which leads to a painful loss of visual acuity, ophthalmoparesis, chemosis, proptosis and ptosis. The rich anastomotic orbital vascularisation from internal carotid artery (ICA) and external carotid artery makes this disorder a rare cause of visual loss in stroke patients. We describe a case of a woman who suffered an acute occlusion of her right ICA and developed an OIS after mechanical thrombectomy.

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

“…The excellent outcome of our patient also contrasts with previous reports of permanent vision loss in OIS after MT. 11,13 The arterial wall inflammatory process may be due to the direct effect of the mechanical forces exerted by the stent retriever, as well as the indirect effect of retrieval of the occluded thrombus that precipitates the release of inflammatory mediators. Previous studies have shown an increased level of inflammatory markers after an ischemic stroke.…”

“…This rare disorder, with less than one hundred cases reported in literature, has been described in relation to infectious and inflammatory diseases, nephrotic syndrome, arterial dissection, hypoperfusion from common carotid artery occlusion and invasive procedures, such as aneurism surgery or endovascular mechanical thrombectomy (MT). [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In 2015, five clinical trials showed the benefit of endovascular MT in acute large vessel occlusions. 15 Since then, an increasing number of stroke patients are being treated with MT and more potentially adverse events have been recognized.…”

Orbital infarction syndrome secondary to rhino-orbital mucormycosis in a case of COVID-19: Clinico-radiological features

“…[ 16 ] OIS is most often the result of extensive ICA or common carotid artery atherothrombotic occlusions. [ 1 2 3 4 5 6 7 8 9 10 11 12 ] Other causes include craniotomies or endovascular procedures,[ 3 4 8 10 12 ] mucomycosis,[ 1 3 ] giant cell arteritis,[ 1 ] and sclerotherapy for vascular malformations. [ 11 ] For patients undergoing craniotomies, the mechanism of OIS is thought to be prolonged extensive pressure onto orbital tissues from improper positioning or direct orbital compression, resulting in inadequate tissue perfusion.…”

“…[ 1 2 3 4 5 6 ] Clinically, it is characterised by a sudden and profound vision loss, periorbital ache, blepharoptosis, total ophthalmoplegia, and chorioretinal ischemia. [ 1 2 3 4 5 6 7 8 9 10 11 12 ] Frequently, the site of arterial occlusion is the common or internal carotid artery (ICA), with very few cases reported due to isolated occlusion of the ophthalmic artery (OA). [ 1 2 3 4 5 6 7 8 9 10 11 12 ] Vascular occlusions are a known association of the novel SARS-CoV2 virus due its ability to induce a thrombogenic state.…”

“…[ 1 2 3 4 5 6 7 8 9 10 11 12 ] Frequently, the site of arterial occlusion is the common or internal carotid artery (ICA), with very few cases reported due to isolated occlusion of the ophthalmic artery (OA). [ 1 2 3 4 5 6 7 8 9 10 11 12 ] Vascular occlusions are a known association of the novel SARS-CoV2 virus due its ability to induce a thrombogenic state. [ 13 ] One of the mainstays of treatment of COVID-19 involves the use of steroids.…”