WASHINGTON — Carotid artery stenting may provide a safe and effective means of restoring ocular blood circulation and improving the vision of patients with severe carotid stenosis, especially those with chronic ocular ischemic syndrome, Dr. Shoichiro Kawaguchi reported at the annual meeting of the American Association of Neurological Surgeons.
“It is well-known that severe internal carotid stenosis influences the flow dynamics of the ophthalmic artery in chronic ocular ischemic syndrome,” said Dr. Kawaguchi of the department of neurosurgery at Nara (Japan) Medical University.
Of the 38 patients in the study with internal carotid artery stenosis of 80% or more, 9 had experienced clinical symptoms of a transient ischemic attack and 29 had reversible ischemic neurologic deficits. Eight of those with reversible ischemic neurologic deficits had chronic ocular ischemic syndrome.
Before undergoing carotid artery stenting (CAS), 13 patients exhibited a reversed flow pattern on ophthalmic artery color Doppler flow imaging, whereas the other 25 patients showed an arch stenosis (antegrade) flow pattern. At 24 hours after CAS, all patients had an antegrade flow pattern and a significant rise in mean peak systolic flow velocity in the ophthalmic artery from −0.038 m/sec before CAS to 0.36 m/sec afterward. All CAS procedures were performed on patients under general anesthesia more than 4 weeks after their last neurologic event.
There was no difference in the degree of carotid stenosis among patients with or without chronic ocular ischemic syndrome, but those with the syndrome had significant improvement in peak systolic flow velocity in the ophthalmic artery.
Measurements did not change significantly from 1 week to 3 months after CAS. Seven of the eight patients with chronic ocular ischemic syndrome improved their visual acuity during the mean follow-up of 2.8 years.