Optical coherence tomography angiography before and after supra-aortic vessels angioplasty and stenting in a patient with ocular ischemic syndrome

Author: Clara Monferrer-Adsuara (Spain)

Co-authors: Verónica Castro-Navarro, Lidia Remolí-Sargues, Catalina Navarro-Palop, Javier Montero-Hernández, Enrique Cervera-Taulet

Purpose

To analyze retinal microvasculature changes using optical coherence tomography angiography (OCTA) images in a bilateral ocular ischemic syndrome (OIS) before and after supra-aortic vessels angioplasty and stenting.

Setting/Venue

Case report. Ophthalmology service, Consorcio Hospital General Universitario de Valencia, Spain.

Methods

A 60-year-old man with a history of heavy smoking, dyslipidemia, coronary revascularization, hypertension and diabetes mellitus presented with a sudden painless vision loss in the right eye (RE). Best corrected visual acuity was light perception in the RE and 20/20 in the left eye (LE). A relative afferent pupillary defect was observed in the RE and rubeosis iridis in the RE was noted. Funduscopy of the RE was suggestive of central retinal artery occlusion; spots blots hemorrhages were noted in the LE as well as arteriolar attenuation. Fluorescein angiography (FA) revealed a delayed choroidal filling time in both eyes, a complete lack of filling of the retinal vessels in the RE and a prolonged arteriovenous transit time in the LE. Carotid-Doppler showed severe bilateral carotid atheromatosis. A percutaneous transfemoral arteriography showed a subtotal brachiocephalic artery stenosis and bilateral common carotid artery complete occlusion. The diagnosis of a bilateral OIS was made. After brachiocephalic artery angioplasty and stenting, improvements were observed in blood flow as assessed by OCTA and FA. The area of the foveal avascular zone (FAZ) and density of the retinal vessel at the level of the superficial and deep retinal layers were analyzed before and after treatment.

Results

Mean superficial FAZ area in the LE was 0.41 mm before treatment, decreasing by 39.02% to 0.25 mm after treatment. Mean deep FAZ area in the LE was 0,36 mm before treatment, decreasing by 30.55% to 0,25 mm after treatment. Superficial or deep vessel density increased by 33.4% and 19.6% after treatment, respectively. The mean subfoveal choroidal thickness in the LE was 147 μm before treatment and 158 μm after treatment; central macular thickness in the LE was 222 μm before treatment and 255 after treatment.

Conlusions

OCTA confirmed FAZ area reduction and increased vessel density in all retinal layers after contralateral supra-aortic vessels angioplasty and stenting for OIS. These findings suggest that unilateral artery angioplasty and stenting for severe supra-aortic vessel stenosis increases macular vessel densities in both eyes. We concluded that OCTA could be a useful tool to assess blood flow and treatment efficacy in OIS.

Financial Disclosure

None