Ophthalmic Artery Occlusion After Carotid Revascularization
A 75-year old man with right hemiparesis and motor aphasia visited our emergency department. Symptom duration was three hours. He had hypertension for which he had been under treatment for ten years. No hemorrhagic lesions or low density areas were revealed by brain computerized tomography. A right internal carotid artery (ICA) angiogram showed collateral circulation to the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) via anterior communicating artery and leptomeningeal anastomoses (). The left ICA bifurcation was filled with thrombus (). A left common carotid artery (CCA) angiogram revealed left proximal cervical ICA occlusion (). The patient underwent CAS. After insertion of an 8 Fr sheath, an 8 Fr guiding catheter (FAS; Boston Scientific, Natick, MA, USA) was introduced into the left CCA. A 4×20 mm balloon (Ultra-soft SV; Boston Scientific, Natick, MA, USA) was used for pre-dilatation followed by stent implantation using an 8×40 mm carotid stent (Acculink; Abbott Vascular, Abbott Park, IL, USA) (). After CAS, the thrombus in distal ICA was removed using the Penumbra aspiration system (Penumbra, Inc., Alameda, CA, USA). Final angiography showed flow restoration in the occluded segment (). After the procedure, the right hemiparesis and motor aphasia improved. The patient was transferred to a hospital near his home.\nTwo months later, the patient visited our ophthalmology department for decreased visual acuity. A careful interview revealed that his visual acuity decreased soon after CAS. Upon examination, the patient's visual acuity in the left eye was finger counting at a distance of 50 cm. Fundus examination revealed a pale optic disc and macular edema. Fluorescein angiography revealed no abnormal finding except a mild delay (18 sec.) in the arm to retina time. We checked the previous cerebral angiogram after CAS and found ophthalmic artery occlusion (). Follow-up of the cerebral angiogram showed no occlusion in the left ophthalmic artery ().