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Soo Chang Cho, Cheolkyu Jung, Joo Yong Lee, Sang Jin Kim, Kyu Hyung Park, Na-Kyung Ryoo, Se Joon Woo; Retinal Artery Occlusion after Intravascular Procedure: Case Series and Literature Review. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3650.
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© ARVO (1962-2015); The Authors (2016-present)
This study presented clinical characteristics of retinal artery occlusion after intravascular procedure and investigated possible mechanisms.
This study is a meta-analysis of retrospective case series including 10 new patients with acute RAO following intravascular procedure and previous case reports of 17 cases of RAO associated with intravascular procedures. Demographic and clinical characteristics of patients from current series and previous reports were presented. Total 27 cases of RAO were categorized into two groups according to assumed etiology; group 1 (dislodged emboli): RAO as a result of emboli from dislodged plaque fragments following procedural manipulation, group 2 (new emboli): RAO as a result of emboli from a newly formed thrombus or from the embolic material used, during the procedure.
Of 27 cases, 17 (63.0%) patients had branch retinal artery occlusion and 10 (37.0%) patients central retinal artery occlusion. Proportion of patients with final BCVA ≥ 20/40 was 61.1%. The anatomical regions of the intravascular procedure were carotid artery (48.1%), heart (25.9%), carotid artery or heart (3.7%), brain (11.1%), scalp/glabellar (7.4%), and thyroid (3.7%). 16 cases were categorized as group 1 and 11 cases were categorized as group 2. Cases of group 1 were related with the dislodged plaque from carotid artery (9 cases, 56.3%) heart (6 cases, 37.5%), or carotid artery/heart (1 case, 6.3%; case with transfermoal cerebral angiography and coronary angiography). Cases of group 2 were related with newly formed thrombi (6 cases, 54.5%) or migrated embolic material via collateral channels between external carotid and ophthalmic arteries (5 cases, 45.5%). 17 (63.0%) patients presented with acute visual disturbance immediately after the procedures, 10 (37.0%) patients showed delayed occurrence (1 day to 3 days after procedure).
In conclusion, retinal artery occlusion can be a complication following intravascular procedures by a dislodged embolic plaque from carotid artery or heart, or by a newly formed thrombus or embolic material via collateral channels. BRAO was presented more often than CRAO after intravascular procedure. RAO with delayed onset can be complicated after intravascular procedure. Therefore, patients should be informed about the possible delayed presentation of RAO, and cautious ophthalmic examination is recommended till a few days after the procedure.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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