Central Retinal Artery Thromboembolism without Ophthalmic Artery Occlusion During Stent-Assisted Coil Embolization of Ophthalmic Artery Aneurysm.

BACKGROUND: Recent reports have described that endovascular treatment of coil embolization of opththalmic artery (OphA) aneurysms has a relative risk of visual disruption caused by thromboembolic infarction of the central retinal artery (CRA), especially the OphA when it originates within the body of the aneurysm. Patent microthrombus in the OphA might also cause retinal infarction that affects visual acuity. We describe stent-assisted coil embolization of an OphA aneurysm complicated with a severe visual disturbance, although normal flow was scrupulously maintained in the OphA during the procedure. The visual disturbance was recovered by early treatment.

CASE DESCRIPTION: A 40-year-old woman who presented with an intracranial aneurysm arising from the right OphA underwent stent-assisted coil embolization under general anesthesia. Although the area around the origin of the OphA was intentionally avoided and anterograde flow in the OphA was monitored by repeated angiography during this procedure, sight in the right eye was lost immediately thereafter. The immediate application of ocular massage and intraarterial fibrinolysis improved vision in the right eye to essentially normal status after discharge.

CONCLUSIONS: Despite good anterograde flow in the OphA during aneurysm embolization, the procedural risk of a visual disturbance due to thromboembolic complications of CRA occlusion cannot be avoided. Anterograde flow in the OphA and retinochoroidal blush should be monitored by repeated angiography during coil embolization to prevent vision loss. Should vision be lost, a rapid response including ocular massage and intraarterial fibrinolysis is required for recovery.