Percutaneous carotid artery angioplasty and stenting for ocular ischemic syndrome

Purpose: To describe percutaneous carotid angioplasty and stenting to treat ocular ischemic syndrome resulting from severe intracranial carotid artery stenosis. Design: Retrospective case series of 3 patients with ocular ischemic syndrome and intracranial carotid artery stenosis. Intervention: All patients underwent carotid artery evaluation, including ultrasound, transcranial Doppler, magnetic resonance imaging or magnetic resonance angiography,and angiography. Carotid angioplasty and stenting was performed in all patients. Main outcome measures: Carotid angiography, fluorescein angiography, and transcranial Doppler imaging were used to evaluate cerebral and ocular perfusion. Results: Cerebral perfusion improved in all patients. Fluorescein angiography arteriovenous transit times improved in 2 patients. One patient had a correction in the reversal of flow through the ophthalmic artery. Visual acuity remained stable or improved in all patients. There were no complications associated with the procedure. Conclusions: Intracranial carotid artery stenosis is a rare cause of ocular ischemic syndrome. With the advent of carotid angioplasty and stenting, stenotic lesions previously not amenable to carotid endarterectomy are now treatable with stenting. A complete work-up of the carotid artery is necessary in all cases of ocular ischemic syndrome to ensure evaluation of the entire carotid artery system. Early diagnosis of intracranial carotid stenosis is important for preservation of visual function and reducing risk of cerebral vascular event. [Copyright &y& Elsevier]