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Abstract：
UNASSIGNED: To describe acute and chronic retinal ischemic changes following an internal carotid artery pseudoaneurysm stenting procedure, and to review current evidence for risk factors and management of post-procedural retinal ischemic events.
UNASSIGNED: A 50-year-old man presented with a 3-month history of pulsatile tinnitus, headache, and intermittent blurry vision. A CT angiogram of head and neck showed bilateral cervicopetrous internal carotid artery (ICA) pseudoaneurysms. The patient underwent successful repair with angioplasty and stenting of the flow-limiting high-grade (>95%) stenosis of his left high cervical ICA. On post-operative day 1, the patient reported monocular vision loss with a large central scotoma. He was found to have a central macular area of retinal whitening and multiple areas of perivascular retinal whitening on exam, concerning for retinal artery occlusions secondary to peri-procedural emboli. Dual antiplatelet therapy was started and a stroke evaluation was performed. Two months later, his visual acuity in the affected eye was counting fingers and his left eye fundus examination was notable for multiple areas of scattered hemorrhages, microaneurysms, and retinal exudates in the distribution of prior retinal ischemia. OCT imaging revealed atrophic changes in the left macula. Subsequently, the patient completed stage-2 repair of the left ICA pseudoaneurysm followed by uncomplicated repair of the right ICA. Four months later, his left eye visual acuity and retinal findings remained stable.
UNASSIGNED: Post-procedure retinal emboli and ischemia are important, vision threatening possible ocular complications for patients undergoing carotid vascular and endovascular procedures.
UNASSIGNED: A 50-year-old man presented with a 3-month history of pulsatile tinnitus, headache, and intermittent blurry vision. A CT angiogram of head and neck showed bilateral cervicopetrous internal carotid artery (ICA) pseudoaneurysms. The patient underwent successful repair with angioplasty and stenting of the flow-limiting high-grade (>95%) stenosis of his left high cervical ICA. On post-operative day 1, the patient reported monocular vision loss with a large central scotoma. He was found to have a central macular area of retinal whitening and multiple areas of perivascular retinal whitening on exam, concerning for retinal artery occlusions secondary to peri-procedural emboli. Dual antiplatelet therapy was started and a stroke evaluation was performed. Two months later, his visual acuity in the affected eye was counting fingers and his left eye fundus examination was notable for multiple areas of scattered hemorrhages, microaneurysms, and retinal exudates in the distribution of prior retinal ischemia. OCT imaging revealed atrophic changes in the left macula. Subsequently, the patient completed stage-2 repair of the left ICA pseudoaneurysm followed by uncomplicated repair of the right ICA. Four months later, his left eye visual acuity and retinal findings remained stable.
UNASSIGNED: Post-procedure retinal emboli and ischemia are important, vision threatening possible ocular complications for patients undergoing carotid vascular and endovascular procedures.
摘要：
■描述颈内动脉假性动脉瘤支架置入手术后的急性和慢性视网膜缺血变化，并回顾手术后视网膜缺血事件的危险因素和管理的现有证据。
■一名50岁的男子，有3个月的搏动性耳鸣病史，头痛,和间歇性模糊的视力。头颈部CT血管造影显示双侧颈内动脉（ICA）假性动脉瘤。患者通过血管成形术和支架置入术成功修复了他的左宫颈高位ICA的流量限制高度（>95％）狭窄。术后第1天，患者报告单眼视力下降，中央暗点大。他在检查中被发现有一个中央黄斑区的视网膜增白和多个血管周围视网膜增白区域，考虑为围手术期栓塞继发的视网膜动脉阻塞。开始双重抗血小板治疗并进行卒中评估。两个月后,他在受影响的眼睛的视力是数指，他的左眼眼底检查值得注意的是多个散见性出血区域，微动脉瘤,和视网膜渗出物在先前视网膜缺血的分布。OCT成像显示左侧黄斑萎缩性改变。随后，患者完成了左侧ICA假性动脉瘤的2期修复,随后进行了右侧ICA的简单修复.四个月后,他的左眼视力和视网膜检查结果保持稳定。
■术后视网膜栓塞和缺血是重要的，对于接受颈动脉血管和血管内手术的患者，可能会威胁视力的眼部并发症。
■一名50岁的男子，有3个月的搏动性耳鸣病史，头痛,和间歇性模糊的视力。头颈部CT血管造影显示双侧颈内动脉（ICA）假性动脉瘤。患者通过血管成形术和支架置入术成功修复了他的左宫颈高位ICA的流量限制高度（>95％）狭窄。术后第1天，患者报告单眼视力下降，中央暗点大。他在检查中被发现有一个中央黄斑区的视网膜增白和多个血管周围视网膜增白区域，考虑为围手术期栓塞继发的视网膜动脉阻塞。开始双重抗血小板治疗并进行卒中评估。两个月后,他在受影响的眼睛的视力是数指，他的左眼眼底检查值得注意的是多个散见性出血区域，微动脉瘤,和视网膜渗出物在先前视网膜缺血的分布。OCT成像显示左侧黄斑萎缩性改变。随后，患者完成了左侧ICA假性动脉瘤的2期修复,随后进行了右侧ICA的简单修复.四个月后,他的左眼视力和视网膜检查结果保持稳定。
■术后视网膜栓塞和缺血是重要的，对于接受颈动脉血管和血管内手术的患者，可能会威胁视力的眼部并发症。
