Retinal Embolization Syndrome as a Perioperative Complication of Surgical Restoration of Internal Carotid Artery - Case Report

Embolization of cholesterol material from atherosclerotic plaques lining the walls of major arteries causes different types of cholesterol embolization syndromes (CES), depending on the organs being involved.CES is most frequently found after cardiovascular procedures and less common after carotid surgery.We describe a case of a 65 -year old heavily smoker male patient of Caucasian origin with high grade symptomatic carotid stenosis.Duplex Doppler examination and angio-CT showed more than 90% unstable plaque in the right carotid artery.Clinically, he presented three transient ischemic attacks (TIA) in the past 2 years, the last one two months before surgical procedure.Carotid endarterectomy (CEA) was performed in local anaesthesia without using shunt and primary closure.Postoperative period was complicated in the second day by important visual deterioration in the right eye and the patient was referred to the Ophthalmological Department.In the indirect ophthalmoscopy of the right eye, a whitening of the superior retinal artery area and many cholesterol plaques was noted.Additionally, performed OCT and fluorescein angiography confirmed a diagnosis of retinal embolization syndrome.The present case report shows that there is a rare possibility of embolic retinal arteries occlusion (RAO) due to CES as a complication of the surgical restoration of internal carotid artery.