Abstract WP16: Symptomatic Retinal Artery Occlusion After Carotid Artery Angioplasty and Stent: Incidence and Related Risk Factors

Abstract

Background: Retinal arterial occlusion (RAO) is one of the rare complications developed after carotid artery angioplasty and stenting (CAS). Therefore, RAO after CAS has not well been documented yet. The aim of this study is to investigate the incidence and risk factor of symptomatic RAO after CAS, focusing on comparing the difference depending on whether ophthalmic artery (OA) before CAS was supplied from external or internal carotid artery (ECA or ICA) Method: A total of 342 patients with carotid stenosis were retrospectively reviewed, each subjected to CAS for severe and/or symptomatic stenosis from January 2009 to December 2017. Cumulative medical records and radiologic data were assessed. RAO was confirmed by fundus photography and fluorescent angiography performed by ophthalmologist. All patients were grouped by supply of OA from which artery, either ICA or ECA dominant. In all patients, distal filter systems with various types were applied as cerebral protection device (CPD) during procedure. Univariate and multivariate analyses were conducted to identify risk factors for RAO after CAS. Result: Symptomatic RAO was observed in 6 patients (1.4%), whom 5 (6.8%) were in ECA dominant group (n=74). In binary logistic regression analysis, OA supplied from ECA (OR, 15.345; 95% CI, 1.061-147.112) and older age (OR, 1.245; 95% CI, 1.035-1.498) were the significant factors related to RAO after CAS. OA supplied from ECA was associated with severity of ipsilateral ICA stenosis (p<0.001), decreased vascular reservoir (p=0.029), common carotid artery involvement (p=0.024), and ulcerative plaque (p=0.006). Conclusion: Under usage of distal filtering system on ICA as CPD, CRO after CAS for severe stenosis was related to OA supplied from ECA. In those patients with old-age, simultaneous ICA-ECA protective CPD might be helpful to prevent RAO after CAS.