Oculocardiac reflex induced by catheterization of the distal ophthalmic artery: Case Report

Abstract

●Abstract● Objective: Oculocardiac reflex sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardic arrhythmia and cardiac arrest. A case of oculocardiac reflex due to catheterization for an anterior cranial fossa dural arteriovenous fistula (DAVF) is reported. Case Report: A 45-year-old man was incidentally diagnosed with an anterior cranial fossa DAVF by magnetic resonance angiogram. Bilateral carotid angiograms revealed the DAVF was supplied by bilateral anterior ethmoidal arteries. An attempt was made at transarterial embolization using a liquid embolic material. The DAVF was mainly supplied by the left anterior ethmoidal artery, however tortuosity of its arterial origin prevented catheterization with a microcatheter. Therefore catheterization was attempted using the right ophthalmic artery. The microcatheter was advanced to an area more distal in the third segment of the right ophthalmic artery to avoid ophthalmic complications. When the microcatheter had been advanced as distally as possible to be close to the shunt point of the DAVF, the patient's pulse rate gradually decreased and temporary cardiac arrest occurred just after the patient complained of eye pain. Immediately after pulling back the microcatheter, the pulse rate began to gradually increase for about 20 seconds. Ultimately, the attempt at transarterial obliteration of the fistula was abandoned. Conclusion: To our knowledge, this is the first report describing a patient that developed an oculocardiac reflex as a result of catheterization of the distal ophthalmic artery. Operators attempting catheterization into the distal ophthalmic artery need to be familiar with this phenomenon.