Korean J Radiol.  2019 Nov;20(11):1546-1553. 10.3348/kjr.2019.0030.

Symptomatic Retinal Artery Occlusion after Angioplasty and Stenting of the Carotid Artery: Incidence and Related Risk Factors

• An SJ
• Cho YD
• Lee J
• Mun JH
• Yoo DH
• Kang HS
• Yang YJ
• Han MH

• KMID: 2459422
• DOI: http://doi.org/10.3348/kjr.2019.0030

Abstract

OBJECTIVE
Retinal artery occlusion (RAO) is rarely seen as a complication in patients undergoing carotid artery stenting (CAS); hence, its characteristics have not been documented in detail. This study aimed to investigate the incidence of this complication and the related risk factors, focusing on differences in ophthalmic artery (OA) supply (whether by the external or internal carotid artery [ECA or ICA]) prior to CAS procedures.
MATERIALS AND METHODS
We retrospectively examined 342 patients who underwent CAS for severe and/or symptomatic carotid artery stenosis between January 2009 and December 2017. Cumulative medical records and radiologic data were assessed. RAO was confirmed by photography and fluorescent angiography of the fundus, which were performed by an ophthalmologist. In all patients, distal filter systems of various types were applied as cerebral protection devices (CPDs) during procedures. Univariate and multivariate analyses were conducted to identify the risk factors for RAO after CAS.
RESULTS
Symptomatic RAO was observed in six patients (1.8%), of which five (6.8%) were ECA-dominant group members (n = 74). In a binary logistic regression analysis, OA supply by the ECA (odds ratio [OR], 9.705; 95% confidence interval [CI], 1.519-62.017; p = 0.016) and older age (OR, 1.159; 95% CI, 1.005-1.336; p = 0.041) were identified as significant risk factors in patients with RAO after CAS. ECA-supplied OA was also associated with the severity of ipsilateral ICA stenosis (p = 0.001) and ulcerative plaque (p = 0.021).
CONCLUSION
In procedures performed using ICA distal filtering CPD systems, RAO as a complication of CAS (performed for severe stenosis) showed a relationship to ECA-supplied OA. For older patients, simultaneous use of ICA-ECA CPDs might help prevent such complications.

Keyword

Carotid artery; Stenosis; Angioplasty; Stent; Retinal artery occlusion

MeSH Terms

Angiography
Angioplasty*
Carotid Arteries*
Carotid Artery, Internal
Carotid Stenosis
Constriction, Pathologic
Humans
Incidence*
Logistic Models
Medical Records
Multivariate Analysis
Ophthalmic Artery
Photography
Retinal Artery Occlusion*
Retinal Artery*
Retinaldehyde*
Retrospective Studies
Risk Factors*
Stents*
Ulcer
Retinaldehyde

Figure

• 

  Fig. 1 Representative case with OA supplied by external carotid artery collaterals.A–C. Sequential lateral views in common carotid angiography showing OA (black arrowheads) supplied by collateral channel via MMA (white arrowheads). D. Working projection of severely stenotic proximal internal carotid artery. E. Successful dilatation achieved after carotid angioplasty and stenting. F. After carotid artery stenting, sluggish OA (black arrowhead) flow supplied by MMA (white arrowhead). G. Fluorescent angiography of fundus showing multiple occlusions of retinal arteries (arrows). MMA = middle meningeal artery, OA = ophthalmic artery

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