J Korean Ophthalmol Soc.  2010 Mar;51(3):447-452.

Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

• Han YS
• Yoo WS
• Chung IY
• Park JM

Abstract

PURPOSE
To report a case of ocular ischemic syndrome successfully treated with delayed carotid angioplasty and stenting (CAS).
CASE SUMMARY
A 52-year-old male was admitted to our hospital because of amaurosis fugax-like symptoms in the right eye for several months. His visual acuity was 0.8 in the right eye and he did not have rubeosis iridis. Neovascularization of the disc, narrowing of the retinal artery and multiple retinal hemorrhages were diagnosed by fundus examination. Fluorescein angiography showed delayed choroidal filling, a delayed arm-to-retina time, prolongation of arteriovenous transit time, neovascularization of the disc, retinal capillary nonperfusion, and staining of the retinal vessels. MR angiography showed severe stenosis in the proximal portion of the right carotid artery. We diagnosed this case as ocular ischemic syndrome. The patient was recommended carotid angioplasty and stenting at the severely narrowed portion of the right carotid artery, but it was postponed about six months after diagnosis because of personal problems. At the final follow-up, 24 months after stenting, the amaurosis fugax symptoms had disappeared, the patient had an improved visual acuity of 1.0, and the new vessels on the disc changed to fibrous tissue. Fluorescein angiography showed resolution of the delayed arm-to-retina time and prolongation of the arteriovenous transit time, disappearances of the leakage around the disc and the retinal capillary nonperfusion.

Keyword

Amaurosis fugax; Carotid angioplasty and stenting (CAS); Ocular ischemic syndrome

MeSH Terms

Amaurosis Fugax
Angiography
Angioplasty
Blindness
Capillaries
Carotid Arteries
Choroid
Constriction, Pathologic
Eye
Fluorescein Angiography
Follow-Up Studies
Humans
Male
Middle Aged
Retinal Artery
Retinal Hemorrhage
Retinal Vessels
Retinaldehyde
Stents
Visual Acuity
Retinaldehyde

Figure

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  Figure 1. Fundus photograph and fluorescein angiography in the early and late phase before (A, B, C) and after (D, E, F) carotid angioplasty and stenting (CAS). (A) Before CAS, fundus photograph shows multiple dot retinal hemorrhage and arterial narrowing. (B) Early phase in fluorescein angiography shows delayed arm-to-retina time and new vessels on disc. (C) Late phase shows leakage from new vessels on the disc and reveals non-perfusion area. (D) After CAS, fundus photograph shows disappearance of new vessels in the disc which is changed to fibrous tissue. (E) Early phase in fluorescein angiography shows disappearance of new vessels on the disc and no delayed arm-to-retina time. (F) Late phase shows no leakage from the disc and well perfused entire retina.

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  Figure 2. Carotid angiography before (A) and after (B) carotid angioplasty and stenting (CAS). (A) Before CAS, the right internal carotid artery shows stenosis more than 90% but, (B) after CAS, successful stenting and good flow are shown (arrow: stenotic site of the carotid artery).

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  Figure 3. CT angiography and reconstructed three dimensional image before (A, B) and after (C, D) carotid angioplasty and stenting (CAS). Before CAS, the lumen of the right carotid artery is stenotic with artheroma (A) and not visible in reconstructed image (B) but after CAS, the lumen is well enhanced with contrast material (C) and well visible in the reconstructed image (D).

Reference

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