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Retinal artery emboli. Indications for angiography and carotid endarterectomy
Insights
Retinal cholesterol emboli indicate a need for carotid arteriography. Ulcerative carotid disease warrants surgical intervention, even without symptoms, to prevent stroke.
Area of Science:
- Vascular Surgery
- Ophthalmology
- Neurology
Background:
- Cholesterol emboli in retinal arteries can indicate underlying carotid artery disease.
- Patients with ocular symptoms from emboli may have significant carotid stenosis or ulceration.
Purpose of the Study:
- To investigate the correlation between retinal cholesterol emboli and ipsilateral carotid artery disease.
- To determine the necessity of carotid endarterectomy in patients with retinal emboli and carotid disease, irrespective of symptoms.
Main Methods:
- Retrospective review of six patients with ocular symptoms and retinal cholesterol emboli.
- Four-vessel aortic arch arteriography to assess carotid artery disease.
- Surgical intervention (carotid endarterectomy) for eligible patients with ulcerative plaques.
Main Results:
- All six patients exhibited significant ipsilateral carotid artery disease.
- Four patients had ulcerative plaques at the carotid bifurcation and underwent successful carotid endarterectomy.
- Two patients had internal carotid artery occlusion and were not candidates for surgery.
Conclusions:
- Retinal cholesterol emboli are a significant indicator for extracranial arteriography.
- Carotid endarterectomy is recommended for ulcerative ipsilateral carotid disease, even in asymptomatic patients, to mitigate stroke risk.
Abstract:
Six patients with ocular symptoms were referred by the Eye Service to the Vascular Service because of the presence of cholesterol emboli on fundoscopic examination of the retinal arteries. None of the six patients had classic intermittent retinal or cerebral ischemic attacks. Four-vessel aortic arch arteriogram was suggested and significant ipsilateral carotid disease was found in all patients. Four patients underwent carotid endarterectomy, with removal of ulcerated plaques from the carotid bifurcation. Two patients had total occlusion of the ipsilateral internal carotid artery and therefore were not operative candidates. The presence of retinal cholesterol emboli is an indication for extracranial arteriography. When ipsilateral ulcerative disease is found, carotid endarterectomy is indicated regardless of the symptoms.