Retinal Artery Embolization During Carotid Angioplasty and Carotid Artery Stenting -Case Report-

Abstract

A 69-year-old man presented with a rare case of retinal artery embolization, which occurred as a complication of carotid angioplasty and carotid artery stenting performed for recurrent cerebral infarction. Magnetic resonance imaging and angiography showed right internal carotid artery stenosis with ulceration. Carotid angioplasty and carotid artery stenting were performed using the distal protection system with the PercuSurge GuardWire. However, just after dilation, the patient complained of ocular pain and blurred vision on the right, which was subsequently diagnosed as retinal artery embolization. Heparin was given for 15 hours after stenting, and aspirin and ticlopidine medication were continued. The patient received hyperbaric oxygen therapy for 1 week. The patient's blurred vision gradually improved, but visual field defect remained. Debris was probably flushed into the external carotid artery, and passed through an anastomosis into the ophthalmic artery, resulting in retinal artery embolization.

Ophthalmic Artery Occlusion After Carotid Revascularization

“…Several studies reported CRAO or BRAO after CAS 8)11-13). Samardzic et al10) reported retinal circulation embolism after cardiac procedures.…”

“…Atherosclerosis of the ophthalmic artery can be another cause of CRAO 11). The third mechanism involves anastomosis between the ophthalmic artery and the external carotid artery 12)13). The ophthalmic artery has numerous extra-orbital branches, which can have extensive anastomoses with the ICA.…”

“…Distal embolization of plaque fragments raises concerns regarding the safety of CAS. Whereas distal embolization resulting from CAS usually occurs in the cerebral hemisphere, it sometimes develops as central or branch retinal artery occlusion (CRAO or BRAO) 8)11-13). However, there have been no reports of ophthalmic artery occlusion.…”

Retinal artery occlusion during carotid artery stenting with distal embolic protection device

“…Retinal artery occlusion (RAO) has also been known to occur in CAS, and various causes have been reported. [4][5][6][7][8][9] According to previous reports, the prevalence of all retinal artery embolisation during CAS is 5-16.9% and that of symptomatic RAO is 1.4-1.7%. 5,7,8 Thus central RAO and branch RAO are not rare complications of CAS; these are very severe complications because they are difficult to treat and result in a decline in activities of daily living caused by the irreversible visual disturbance.…”