Ocular Ischemic Syndrome and the Role of Carotid Artery Revascularization

Shanzay Suhail; Tiziano Tallarita; Irina Kanzafarova; Jenny Lau; Sasha Mansukhani; Sunday Olatunji; Andrew D Calvin; Bayan Moustafa; James Manz; Indrani Sen

doi:10.1016/j.avsg.2023.12.098

Ocular Ischemic Syndrome and the Role of Carotid Artery Revascularization

Ann Vasc Surg. 2024 Apr 2:105:165-176. doi: 10.1016/j.avsg.2023.12.098. Online ahead of print.

Authors

Affiliations

¹ Vascular and Endovascular Surgery, Mayo Clinic Health System, Eau Claire, WI. Electronic address: suhailshanzay98@gmail.com.
² Vascular and Endovascular Surgery, Mayo Clinic Health System, Eau Claire, WI.
³ Vascular and Endovascular Surgery, Rochester, NY.
⁴ Ophthalmology, Mayo Clinic Health System, Eau Claire, WI.
⁵ Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI.
⁶ Neurology, Mayo Clinic Health System, Eau Claire, WI.
⁷ Neurologic Surgery Mayo Clinic Health System, Eau Claire, WI.
⁸ Vascular and Endovascular Surgery, Mayo Clinic Health System, Eau Claire, WI. Electronic address: indrani.sen@mayo.edu.

PMID: 38574808
DOI: 10.1016/j.avsg.2023.12.098

Abstract

Background: Ocular ischemic syndrome (OIS) is a rare presentation of atherosclerotic carotid artery stenosis that can result in permanent visual loss. This severely disabling syndrome remains under diagnosed and undertreated due to lack of awareness; especially since it requires expedited multidisciplinary care. The relevance of early diagnosis and treatment is increasing due to an increasing prevalence of cerebrovascular disease.

Methods: The long-term visual and cerebrovascular outcomes following intervention for nonarteritic OIS, remain poorly described and were the objective of this concise review. We conducted a PubMed search to include all English language publications (cohort studies and case reports) between 2002 and 2023.

Results: A total of 33 studies (479 patients) report the outcomes of treatment of OIS with carotid endarterectomy (CEA, 304 patients, 19 studies), and carotid artery stenting (CAS, 175 patients, 14 studies). Visual outcomes were improved or did not worsen in 447 patients (93.3%). No periprocedural stroke was reported. Worsening visual symptoms were rare (35 patients, 7.3%); they occurred in the immediate postoperative period secondary to ocular hypoperfusion (3 patients) and in the late postoperative period due to progression of systemic atherosclerotic disease. Symptomatic recurrence due to recurrent stenosis after CEA was reported in 1 patient (0.21%); this was managed successfully with CAS. None of these studies report the results of transcarotid artery revascularization, the long-term operative outcome or stroke rate.

Conclusions: OIS remains to be an underdiagnosed condition. Early diagnosis and prompt treatment are crucial in reversal or stabilization of OIS symptoms. An expedited multidisciplinary approach between vascular surgery and ophthalmology services is necessary to facilitate timely treatment and optimize outcome. If diagnosed early, both CEA and CAS have been associated with visual improvement and prevention of progressive visual loss.

Publication types

Review