Surgical intervention for carotid artery stenosis in patients with ocular arterial occlusive disorders

Leah Kim1,2, John Crozier3

Meeting:  2019 RANZCO


Date:      -

Session Title: Retina

Session Time:      -

Purpose: Carotid artery stenosis produces ischemia in ocular arterial occlusive disorders by causing emboli or restricting perfusion to the ocular vasculature. This study compares the incidence and severity of carotid artery disease in Amaurosis Fugax (AF), Branch and Central Retinal Artery Occlusions (BRAO and CRAO respectively), Ocular Ischemic Syndrome (OIS), and Non‐arteritic Anterior Ischemic Optic Neuropathy (NAION). The clinical value of comparing the visual outcomes of carotid endarterectomy (CEA) and carotid artery stenosis (CAS) was also assessed.

Methods: Retrospective cohort study of patients with ocular arterial occlusive disorders presenting to a single tertiary hospital between the years 2007‐2017.

Results: 65 patients presented with an ocular arterial occlusive disorder ‐ 58.5% AF, 16.9% CRAO, 12.3% OIS, 7.7% BRAO, and 4.6% NAION. Carotid stenosis was most prevalent in AF (n = 24), BRAO/CRAO (n = 7), and OIS (n = 4). 26 patients received surgical intervention ‐ 52.6% of patients with AF (n = 20; 12 CEA vs 8 CAS), 25% of OIS (n = 2; 1 CEA vs 1 CAS), and 25% of BRAO/CRAO (n = 4; all had CEA). The most common complication of carotid surgical intervention was post‐operative hypotension. There was insufficient data on the visual outcomes of CEA and CAS.

Conclusion: Carotid artery stenosis was present in at least 50% of patients in each ocular arterial occlusive disorder where data was available. Statistically meaningful conclusions could not be made on the operative complications and improvements in vision from CEA and CAS. Standardising documentation practices would assist in the assessment of visual outcomes of CEA and CAS in these patients.