Relationship between ophthalmic artery flow direction and visual deterioration after carotid angioplasty and stenting

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  • 1 Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang;
  • 2 Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul;
  • 3 Department of Ophthalmology, Apgujung St. Mary’s Eye Center, Seoul;
  • 4 Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul; and
  • 5 Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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OBJECTIVE

Visual deterioration is one of the disabling complications that can occur after carotid angioplasty and stenting (CAS). The purpose of this study was to evaluate the risk factors for newly developed visual symptoms after CAS, focusing on ophthalmic artery (OA) flow pattern and etiology of visual loss.

METHODS

A retrospective review of 127 patients with 138 internal carotid artery (ICA) stenosis lesions that were treated with CAS from February 2009 to October 2017 in a single institution was performed. The flow pattern of the OA was evaluated with digital subtraction angiography and classified into 3 types: type I, antegrade OA flow before and after CAS; type II, antegrade OA flow reversal after CAS; and type III, retained nonantegrade OA flow after CAS.

RESULTS

The degree of ipsilateral ICA stenosis was significantly higher in the nonantegrade group than that in the antegrade group (81.73% ± 9.87% vs 75.74% ± 10.27%, p = 0.001). Independent risk factors for newly developed visual symptoms after CAS were visual symptoms before CAS (OR 65.29, 95% CI 5.14–827.2; p = 0.001) and type III OA flow pattern (OR 55.98, 95% CI 2.88–1088.0; p = 0.008). The post-CAS visual symptoms in 10 patients were related to acute elevation of intraocular pressure in 6 patients and retinal artery occlusion in 3 patients.

CONCLUSIONS

Maintained retrograde or undetected OA flow after CAS and initial visual symptoms before CAS were related to post-CAS visual symptoms. Thus, careful attention is needed for these patients during the perioperative period, and immediate evaluation and management are required for patients with post-CAS visual loss.

ABBREVIATIONS CAS = carotid angioplasty and stenting; DSA = digital subtraction angiography; ECA = external carotid artery; EPD = embolic protection device; ICA = internal carotid artery; IOP = intraocular pressure; NASCET = North American Symptomatic Carotid Endarterectomy Trial; OA = ophthalmic artery.

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Contributor Notes

Correspondence Jai Ho Choi: Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea. bivalvia@catholic.ac.kr.

INCLUDE WHEN CITING Published online September 27, 2019; DOI: 10.3171/2019.6.JNS19906.

Y.K.P. and K.L. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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