Ocular ischemic syndrome during carotid balloon occlusion testing

Area of Science:

• Neurology
• Ophthalmology
• Vascular Surgery

Background:

• Internal carotid artery (ICA) occlusion testing is crucial for stroke risk assessment.
• Temporary ICA occlusion with a double-lumen balloon catheter allows concurrent perfusion.
• Potential complications include ocular ischemic syndrome (OIS).

Purpose of the Study:

• To describe the mechanism of OIS during ICA occlusion testing.
• To highlight preventative technical adjustments.
• To clarify diagnostic interpretation of visual changes.

Main Methods:

• Utilized a double-lumen balloon catheter for ICA occlusion.
• Administered heparinized saline for distal perfusion.
• Observed for signs and symptoms of OIS.

Main Results:

• Rapid saline infusion can displace oxygenated blood in the ophthalmic artery.
• This displacement leads to ipsilateral orbital pain and uniocular visual loss (OIS).
• Failure to recognize OIS can lead to misinterpretation of occlusion test results.

Conclusions:

• Ocular ischemic syndrome during ICA occlusion testing is a preventable complication.
• Awareness of OIS prevents misdiagnosis of positive occlusion tests or thromboembolic events.
• Proper technique ensures accurate assessment of cerebrovascular reserve.