Purtscher-like retinopathy following mechanical thrombectomy: A case report

Stroke is the leading cause of death among Chinese residents, a common form of which is acute large-vessel occlusion ischemic stroke, characterized by high incidence, disability, and mortality rates. To improve stroke prognosis, mechanical thrombectomy has been promoted as an effective treatment, but it involves risks of such complications as hemorrhagic transformation (symptomatic or asymptomatic bleeding), new distal embolism, reocclusion, restenosis, intraoperative vascular dissection, perforation, spasm, and hyperperfusion syndrome. As a case study, this article reports a 66-year-old male patient who suddenly developed acute cerebral infarction with acute occlusion of the left middle cerebral artery M1 segment. After mechanical thrombectomy, the patient experienced a rare complication of Purtscher-like retinopathy, causing significant vision loss in the left eye. Fundus fluorescein angiography indicated occlusion of the branch retinal artery, considered to be caused by microemboli fragmentation, escape, and blockage of the branch retinal artery during mechanical thrombectomy. Follow-up at 1, 6 months, and 1 year after discharge showed no significant improvement in the patient's vision. An in-depth analysis of its mechanism and imaging features suggests that optimization of mechanical thrombectomy devices can significantly improve procedural outcomes. For instance, the use of intermediate catheters-such as the Penumbra ACE series or Navien catheters-in combination with stent retrievers can enhance thrombus engagement and retrieval efficiency, thereby reducing the risk of distal embolization and lowering the incidence of procedure-related complications.