Effect of CEA and CAS for Ocular Circulation and Chronic Ocular Ischemic Syndrome Shoichiro Kawaguchi MD Nara Prefcture Western Medical Center, Nara, Japan

Introduction Conclusions One of the important clinical aspects of Conclusion: Carotid revascularization internal carotid artery stenosis at its origin surgery was effective in improving the is the influence on the flow dynamics of ocular circulation, and it was also the ocular circulation. The blood supply to useful for the chronic OIS due to the the eye is mostly provided by branches of the ophthalmic artery (OphAr), which is a carotid artery stenosis. branch of the internal carotid artery. This is why many patients with cerebral Learning Objectives ischemia in the internal carotid artery may Participants can learn the effect of the present with ipsilateral visual symptoms carotid revascularization surgery (CEA [1]. The disturbed ocular circulation Results Illustrative case and CAS) for the ocular circulation and correlates with chronic ocular ischemic Results: 1) Ocular circulation: A 77-year-old man was referred to our the chronic ocular ischemic syndrome. syndrome symptoms such as frequent Preoperatively, the average OphAr hospital complaining of transient right amaurosis fugax or a decline of visual peak systolic flow velocity (Vs) was hemiparesis and left visual acuity acuity [2,3]. Carotid revascularization 0.05 m/sec, and the average CRA Vs decline. Left carotid angiography surgery, such as carotid endarterectomy References was 0.07 m/sec. At 1 week after showed 98% stenosis of the right (CEA) and carotid artery stenting (CAS), S. Kawaguchi, T. Sakaki, T. Morimoto et al., “Effects of may also restore the cerebral perfusion surgery, the average OphAr Vs internal carotid artery at its origin bypass on ocular ischaemic syndrome caused reversed pressure and improve the intracranial significantly increased to 0.32 m/sec (Fig. 2A). The left OphAr CDFI showed flow in the ophthalmic artery,” Lancet, vol.354, pp2052- vascular hemodynamics including ocular (p < 0.05), and the average CRA Vs reversed flow, and the peak systolic 2053, 1999. S. Kawaguchi, S. Okuno, T. Sakaki et al., “Effect of circulation. Therefore, carotid artery significantly increased to 0.11 m/sec flow velocity was - 0.62 m/sec (Fig. carotid endarterectomy on chronic ocular ischemic revascularization surgery reduces the risk (p < 0.05). These significant 2B). The left CRA peak systolic flow syndrome due to internal carotid artery stenosis,” of stroke in symptomatic and improvements were sustained velocity was 0.06 m/sec (Fig. 2C). Left Neurosurgery, vol.49, pp.328-333, 2001. asymptomatic patients [4, 5]. Despite this throughout the three months of the CEA was performed. Postoperative S. Kawaguchi, T. Sakaki, H. Iwahashi et al., “Effect of well-established benefit, there have been Carotid Artery Stenting on the Ocular Circulation and follow up.2) OIS: During the follow-up carotid angiography showed the good few reports concerning the effect of carotid Chronic Ocular Ischemic Syndrome,” Cerebrovasc Dis, period (mean: 3.8 years), 16 patients patency of the carotid artery (Fig. revascularization surgery for ocular vol.22, pp.402-408, 2006. circulation. Therefore, it is significant to (62%) showed visual acuity 2D). At 1 week after CEA, the left improvement, and no patients OphAr CDFI showed resolution of the understand the ocular circulation and ocular symptoms in patients with internal complained of amaurosis fugax or reversed flow, and the peak flow carotid artery stenosis before and after worsening of the chronic OIS. velocity was 0.30 m/sec (Fig. 2E). The CAS. peak systolic flow velocity of the CRA In this study, we discussed and analyzed was 0.12 m/sec (Fig. 2F). At 1 month the effect of carotid revascularization and 3 months after CEA, there was no surgery on the ocular circulation and marked change of the peak systolic chronic ocular symptoms in patients with flow velocity of OphAr and CRA. carotid artery stenosis. The right visual acuity gradually

improved at 3 months after CEA. The patient was followed up for 2.8 years after CEA, and there were no neurological ischemic events including visual symptoms.