Korean J Ophthalmol.  2009 Mar;23(1):53-56. 10.3341/kjo.2009.23.1.53.

Two Cases of Branch Retinal Arterial Occlusion After Carotid Artery Stenting in the Carotid Stenosis

• Lee SJ
• Kim SY
• Kim SD

• KMID: 1115654
• DOI: http://doi.org/10.3341/kjo.2009.23.1.53

Abstract

We describe two cases of branch retinal artery occlusion (BRAO) after carotid artery (CA) stenting. Case 1: A 57-year-old man diagnosed with left neovascular glaucoma was admitted to our department for trabeculectomy (He had complained of decreased visual acuity (VA) in the left eye for a month). A preoperative neck angio CT scan showed bilateral CA stenosis. After CA stenting, he contracted visual defects on the right superior area of his right eye. Upon examination, VA with correction was found to be 1.0 (OD), but right fundoscopy revealed ischemic retina whitening along the inferior temporal arcade. Case 2: A 64-year-old man received left CA stenting for severe stenosis in the Department of Neurology. The next day, he was referred to us for acute onset of a left naso-inferior visual field defect. Upon initial examination, his VA with correction was 0.8/0.16 (OD/OS) and fundoscopy revealed ischemic retina whitening at the superior posterior pole in the left eye. It was not necessary to treat the BRAO in these cases because the foveal capillary network was not invaded at 2 month follow ups, VA was preserved in both cases. In conclusion, ophthalmic evaluation is important after CA stenting because of a possible embolic occlusion of the retinal artery.

Keyword

Retinal artery occlusion; Carotid stenosis; Carotid stenting

MeSH Terms

Angiography
Carotid Stenosis/radiography/*surgery
Fibrinolytic Agents/therapeutic use
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Male
Middle Aged
Retinal Artery Occlusion/diagnosis/drug therapy/*etiology
Stents/*adverse effects
Visual Acuity
Visual Fields

Figure

• 

  Fig. 1 (A) Trans-femoral carotid angiography shows bilateral partial occlusion of the internal carotid artery at the proximal branching portion (arrow). (B) The red-free photograph of fundus shows ischemic retina whitening at the inferior posterior pole except the fovea. (C) The fluorescein angiogram at 30 seconds after dye injection shows choroidal hypoperfusion and no filling of the retinal artery or vein in inferotemporal posterior pole. (D) The visual field test shows visual defects of the superior nasal quadrant and the superior temporal field in the right eye.

• 

  Fig. 2 (A) Trans-femoral carotid angiography shows partial occlusion of the left internal carotid artery at the proximal branching portion (arrow). (B) The color photograph of fundus shows ischemic retina whitening at the superior posterior pole except the fovea. (C) The fluorecein angiogram shows delayed filling (black arrows), embol (white arrows) and perivascular leaking in the superior temporal artery of the left eye.

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