Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

Yong Seop Han; Woong Sun Yoo; In Young Chung; Jong Moon Park

doi:10.3341/jkos.2010.51.3.447

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Han, Yoo, Chung, and Park: Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

Original Article

J Korean Ophthalmol Soc 2010;51(3):447-451.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.447

Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

Yong Seop Han, MD¹, Woong Sun Yoo, MD¹, In Young Chung, MD^1,², Jong Moon Park, MD, PhD^1,

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Jong Moon Park, MD, PhD Department of Ophthalmology, Gyeongsang National University School of Medicine #90 Chilam-dong, Jinju 660-702, Korea Tel: 82-55-750-8170, Fax: 82-55-758-4158, E-mail: parkjm@gnu.ac.kr

Received 31 July 2009 Accepted 10 November 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purposse

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.

Keywords: Amaurosis fugax, Carotid angioplasty and stenting(CAS), Ocular ischemic syndrome

References

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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.

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).

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).

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