Central retinal artery occlusion: A rare complication of carotid artery stenting

Carotid artery stenting (CAS) has become a promising alternative to carotid endarterectomy in the management of atherosclerotic carotid artery disease. A 68-year-old woman with diabetes and hypertension presented with an ischemic infarct in the right precentral gyrus. The patient was diagnosed with carotid stenosis, and she underwent CAS. Severe postoperative complications in the form of decreased visual acuity and visual field defect arose, and she was eventually diagnosed with central retinal artery occlusion, resulting in a near-total loss of unilateral vision. CAS reduces carotid plaques; however, it can lead to significant shedding of carotid plaques, followed by retinal artery embolism and ultimately serious loss of vision. This complication is of paramount importance, and it requires ample consideration from the interventionist before CAS. Ophthalmic evaluation is vital following CAS, and it is imperative that patients be informed of the risk of permanent vision loss. We herewith emphasize preoperative visual assessment in patients undergoing carotid revascularization who have risk factors for ocular sequelae.